Provider Demographics
NPI:1952915761
Name:EHRHARDT, CAROL (SPEECH LANGUAGE PATH)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:EHRHARDT
Suffix:
Gender:F
Credentials:SPEECH LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 E DESTIN LN
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-2253
Mailing Address - Country:US
Mailing Address - Phone:417-327-9381
Mailing Address - Fax:
Practice Address - Street 1:620 E DESTIN LN
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-2253
Practice Address - Country:US
Practice Address - Phone:417-327-9381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-31
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO113807235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist