Provider Demographics
NPI:1679549117
Name:ALLEN, CHARLOTTE-ANNE BREWER (SLP/CCC, MA)
Entity type:Individual
Prefix:
First Name:CHARLOTTE-ANNE
Middle Name:BREWER
Last Name:ALLEN
Suffix:
Gender:F
Credentials:SLP/CCC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1298 CLINGMAN RD
Mailing Address - Street 2:
Mailing Address - City:RONDA
Mailing Address - State:NC
Mailing Address - Zip Code:28670-8993
Mailing Address - Country:US
Mailing Address - Phone:336-984-2606
Mailing Address - Fax:
Practice Address - Street 1:119 SOUTH JACKSON STREET
Practice Address - Street 2:
Practice Address - City:YADKINVILLE
Practice Address - State:NC
Practice Address - Zip Code:27055-1268
Practice Address - Country:US
Practice Address - Phone:336-679-2112
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1865235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10707OtherBCBSNC
NC7410707Medicaid