Provider Demographics
NPI:1194963439
Name:EBNER, CAROLYN W
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:W
Last Name:EBNER
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 1:220 W KENNEDY ST
Mailing Address - Street 2:SCSD PRE-KINDERGARTEN PROGRAM
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13205-1057
Mailing Address - Country:US
Mailing Address - Phone:315-435-4276
Mailing Address - Fax:315-435-6553
Practice Address - Street 1:416 E RAYNOR AVE
Practice Address - Street 2:DR. MARTIN LUTHER KING SCHOOL
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-3951
Practice Address - Country:US
Practice Address - Phone:315-435-6000
Practice Address - Fax:315-435-6207
Is Sole Proprietor?:No
Enumeration Date:2009-01-24
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007800-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist