Provider Demographics
NPI:1053621136
Name:SMALLWOOD, CAROLYN HUNTER
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:HUNTER
Last Name:SMALLWOOD
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 1:2180 A1A S STE 202
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-6523
Mailing Address - Country:US
Mailing Address - Phone:904-377-7947
Mailing Address - Fax:904-471-6236
Practice Address - Street 1:2180 A1A S STE 202
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-6523
Practice Address - Country:US
Practice Address - Phone:904-377-7947
Practice Address - Fax:904-471-6236
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 3414235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist