Provider Demographics
NPI:1811228638
Name:CARR, JO ELLEN (MACCC-SLP)
Entity type:Individual
Prefix:MS
First Name:JO
Middle Name:ELLEN
Last Name:CARR
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3606 DEVILLE DR
Mailing Address - Street 2:
Mailing Address - City:FLOYDS KNOBS
Mailing Address - State:IN
Mailing Address - Zip Code:47119-9773
Mailing Address - Country:US
Mailing Address - Phone:614-940-9295
Mailing Address - Fax:
Practice Address - Street 1:3606 DEVILLE DR
Practice Address - Street 2:
Practice Address - City:FLOYDS KNOBS
Practice Address - State:IN
Practice Address - Zip Code:47119-9773
Practice Address - Country:US
Practice Address - Phone:614-940-9295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-18
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist