Provider Demographics
NPI:1992483028
Name:ROESSLE, CARLIE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:CARLIE
Middle Name:
Last Name:ROESSLE
Suffix:
Gender:F
Credentials: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:PO BOX 51025
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-1025
Mailing Address - Country:US
Mailing Address - Phone:843-594-3032
Mailing Address - Fax:843-285-5921
Practice Address - Street 1:9730 DORCHESTER RD UNIT 206
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-9034
Practice Address - Country:US
Practice Address - Phone:843-594-3032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6946235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist