Provider Demographics
NPI:1174947808
Name:HISZEM, CAROL (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:
Last Name:HISZEM
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 W PEARL ST
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:OH
Mailing Address - Zip Code:44890-1323
Mailing Address - Country:US
Mailing Address - Phone:419-935-5341
Mailing Address - Fax:
Practice Address - Street 1:206 W PEARL ST
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:OH
Practice Address - Zip Code:44890-1323
Practice Address - Country:US
Practice Address - Phone:419-935-5341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-17
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.6462235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist