Provider Demographics
NPI:1598278889
Name:CAULEY, CARLY JEAN (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:JEAN
Last Name:CAULEY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:
Other - Last Name:FLEMING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:164 PILLSBURY DR SE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0279
Mailing Address - Country:US
Mailing Address - Phone:563-349-6266
Mailing Address - Fax:
Practice Address - Street 1:164 PILLSBURY DR SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0279
Practice Address - Country:US
Practice Address - Phone:563-349-6266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8881235Z00000X
MN459929235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist