Provider Demographics
NPI:1306056627
Name:WALTERS, CAROLINE ANNE (MA CCC SLP)
Entity type:Individual
Prefix:MISS
First Name:CAROLINE
Middle Name:ANNE
Last Name:WALTERS
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1170 PARTRIDGE LN
Mailing Address - Street 2:#201
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34104-8850
Mailing Address - Country:US
Mailing Address - Phone:239-877-4014
Mailing Address - Fax:239-455-6929
Practice Address - Street 1:9510 BONITA BEACH RD SE
Practice Address - Street 2:SUITE 102
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4699
Practice Address - Country:US
Practice Address - Phone:239-333-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 7206235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist