Provider Demographics
NPI:1396083317
Name:FEASTER, CARRIE LYNN (MS CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:LYNN
Last Name:FEASTER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:LYNN
Other - Last Name:FRANK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:1066 CHESAPEAKE POINTE DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47909-8521
Mailing Address - Country:US
Mailing Address - Phone:765-532-5153
Mailing Address - Fax:
Practice Address - Street 1:502 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:MULBERRY
Practice Address - State:IN
Practice Address - Zip Code:46058-9538
Practice Address - Country:US
Practice Address - Phone:765-296-2911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-25
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22005825A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist