Provider Demographics
NPI:1457525438
Name:CAPEHART, CARRIE JONELLE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:JONELLE
Last Name:CAPEHART
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 1:1534 CANDLEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-3166
Mailing Address - Country:US
Mailing Address - Phone:219-395-6194
Mailing Address - Fax:219-921-0780
Practice Address - Street 1:1534 CANDLEWOOD CT
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-3166
Practice Address - Country:US
Practice Address - Phone:219-395-6194
Practice Address - Fax:219-921-0780
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-21
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003777A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist