Provider Demographics
NPI:1649669383
Name:BAUER, CAROLYN (MA, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:CAROLYN
Middle Name:
Last Name:BAUER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 W 4TH ST
Mailing Address - Street 2:SUITE 010
Mailing Address - City:FOSTORIA
Mailing Address - State:OH
Mailing Address - Zip Code:44830-1864
Mailing Address - Country:US
Mailing Address - Phone:419-436-8320
Mailing Address - Fax:
Practice Address - Street 1:610 PLAZA DR
Practice Address - Street 2:
Practice Address - City:FOSTORIA
Practice Address - State:OH
Practice Address - Zip Code:44830-1354
Practice Address - Country:US
Practice Address - Phone:419-436-8321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.11816235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist