Provider Demographics
NPI:1194115345
Name:SUDDATH, CAROL
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:SUDDATH
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 1:2011 TIMBER LN
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-4528
Mailing Address - Country:US
Mailing Address - Phone:093-727-5746
Mailing Address - Fax:937-275-8434
Practice Address - Street 1:2011 TIMBER LN
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-4528
Practice Address - Country:US
Practice Address - Phone:093-727-5746
Practice Address - Fax:937-275-8434
Is Sole Proprietor?:No
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.2507235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist