Provider Demographics
NPI:1588953277
Name:THORNTON, CARRIE BRYANT (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:BRYANT
Last Name:THORNTON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8330 HINSDALE WAY
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-4240
Mailing Address - Country:US
Mailing Address - Phone:850-668-1767
Mailing Address - Fax:
Practice Address - Street 1:8330 HINSDALE WAY
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-4240
Practice Address - Country:US
Practice Address - Phone:850-668-1767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 8557235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist