Provider Demographics
NPI:1780147611
Name:CANNY, CARA MAE
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:MAE
Last Name:CANNY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 W NINE MILE RD UNIT 1207
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32534-5356
Mailing Address - Country:US
Mailing Address - Phone:205-242-9891
Mailing Address - Fax:
Practice Address - Street 1:114 3RD ST SE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-5401
Practice Address - Country:US
Practice Address - Phone:850-243-6134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist