Provider Demographics
NPI:1023880028
Name:BRACKSIECK, CAROLINE (MS, CCC/SLP)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:BRACKSIECK
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18837 PARTING OAKS LN
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-8802
Mailing Address - Country:US
Mailing Address - Phone:713-825-5146
Mailing Address - Fax:
Practice Address - Street 1:507 WAKEFIELD DR APT C
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3148
Practice Address - Country:US
Practice Address - Phone:704-285-8207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist