Provider Demographics
NPI:1528108131
Name:FELLER, CAROLYN CREELY (SLP)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:CREELY
Last Name:FELLER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 BAYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-1562
Mailing Address - Country:US
Mailing Address - Phone:631-421-5378
Mailing Address - Fax:
Practice Address - Street 1:2171 JERICHO TPKE
Practice Address - Street 2:SUITE 340
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2937
Practice Address - Country:US
Practice Address - Phone:631-499-5595
Practice Address - Fax:631-499-3060
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008735-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist