Provider Demographics
NPI:1215338181
Name:SQUIRES, CARLEE ANN (AUD)
Entity type:Individual
Prefix:DR
First Name:CARLEE
Middle Name:ANN
Last Name:SQUIRES
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:CARLEE
Other - Middle Name:ANN
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:2012 GARFIELD AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-2539
Mailing Address - Country:US
Mailing Address - Phone:304-428-2403
Mailing Address - Fax:304-428-3270
Practice Address - Street 1:2012 GARFIELD AVE STE 4
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-2539
Practice Address - Country:US
Practice Address - Phone:304-428-2403
Practice Address - Fax:304-428-3270
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVA-0316231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist