Provider Demographics
NPI:1386992618
Name:PAVELL, CARRIE MARIE (BC-HIS)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:MARIE
Last Name:PAVELL
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 CHESHIRE PKWY N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-4103
Mailing Address - Country:US
Mailing Address - Phone:888-510-0766
Mailing Address - Fax:763-268-4017
Practice Address - Street 1:9451 N 99TH AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-6999
Practice Address - Country:US
Practice Address - Phone:480-217-7743
Practice Address - Fax:623-434-9738
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHAD6138237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist