Provider Demographics
NPI:1265615678
Name:GREENWALD, CAROL
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:GREENWALD
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 1:324 BUENA VISTA PL
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-5400
Mailing Address - Country:US
Mailing Address - Phone:901-278-1556
Mailing Address - Fax:901-278-1556
Practice Address - Street 1:324 BUENA VISTA PL
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112-5400
Practice Address - Country:US
Practice Address - Phone:901-278-1556
Practice Address - Fax:901-278-1556
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000002855235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNSP0000002855OtherLICENSE
00784991OtherASHA CERTIFICATION
ARSP481OtherLICENSE