Provider Demographics
NPI:1053133165
Name:HERMANOWICZ, CAROL (MA CCC SLP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:HERMANOWICZ
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 1:1044 BLANTON ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NC
Mailing Address - Zip Code:28722-3442
Mailing Address - Country:US
Mailing Address - Phone:321-543-9582
Mailing Address - Fax:
Practice Address - Street 1:70 OAK ST
Practice Address - Street 2:
Practice Address - City:TRYON
Practice Address - State:NC
Practice Address - Zip Code:28782-3797
Practice Address - Country:US
Practice Address - Phone:828-859-9161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-29
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30001320235Z00000X
SC8673235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist