Provider Demographics
NPI:1245962943
Name:KING, CAROLINE HANNON (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:HANNON
Last Name:KING
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:CAROLINE
Other - Middle Name:SUZANNE
Other - Last Name:HANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1569 WOODWIND CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-2028
Mailing Address - Country:US
Mailing Address - Phone:239-777-5444
Mailing Address - Fax:
Practice Address - Street 1:1569 WOODWIND CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-2028
Practice Address - Country:US
Practice Address - Phone:239-777-5444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
19364235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist