Provider Demographics
NPI:1295950525
Name:MAYNARD, CAROLINE J (MS CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:J
Last Name:MAYNARD
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:PO BOX #190
Mailing Address - Street 2:GOVERNOR WENTWORTH REGIONAL SCHOOL DISTRICT
Mailing Address - City:WOLFEBORO FALLS
Mailing Address - State:NH
Mailing Address - Zip Code:03896
Mailing Address - Country:US
Mailing Address - Phone:603-569-5167
Mailing Address - Fax:
Practice Address - Street 1:140 PINE HILL RD
Practice Address - Street 2:GOVERNOR WENTWORTH REGIONAL SCHOOL DISTRICT
Practice Address - City:WOLFEBORO FALLS
Practice Address - State:NH
Practice Address - Zip Code:03896
Practice Address - Country:US
Practice Address - Phone:603-569-5167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHP-370235Z00000X
NHNH1163235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHP-370OtherSLP TEMP. LIC. #