Provider Demographics
NPI:1528499340
Name:PETHICK, CAREY
Entity type:Individual
Prefix:
First Name:CAREY
Middle Name:
Last Name:PETHICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 DOUBLE SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-8174
Mailing Address - Country:US
Mailing Address - Phone:803-827-3350
Mailing Address - Fax:803-827-3354
Practice Address - Street 1:22 DOUBLE SPRINGS RD
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-8174
Practice Address - Country:US
Practice Address - Phone:803-827-3350
Practice Address - Fax:803-827-3354
Is Sole Proprietor?:No
Enumeration Date:2013-12-04
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4223235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist