Provider Demographics
NPI:1700973302
Name:SALLEE, CARRIE BAKER (MS,, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:BAKER
Last Name:SALLEE
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 1:16419 PINE GROVE LN
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72916-9245
Mailing Address - Country:US
Mailing Address - Phone:479-996-3192
Mailing Address - Fax:
Practice Address - Street 1:2713 S 74TH ST STE 302
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5155
Practice Address - Country:US
Practice Address - Phone:479-478-8555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR337235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5S602OtherBLUE CROSS BLUE SHIELD