Provider Demographics
NPI:1245721075
Name:FALADE, CARA L (SLP)
Entity type:Individual
Prefix:MS
First Name:CARA
Middle Name:L
Last Name:FALADE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:CARA
Other - Middle Name:L
Other - Last Name:WALTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:510 E NORTH BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-4114
Mailing Address - Country:US
Mailing Address - Phone:614-263-5151
Mailing Address - Fax:
Practice Address - Street 1:510 E NORTH BROADWAY ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-4114
Practice Address - Country:US
Practice Address - Phone:614-263-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP13381235Z00000X
OHCOND.2018667-SP235Z00000X
OHCOND.2018667390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSP13381OtherSTATE LICENSE