Provider Demographics
NPI:1265758866
Name:HURST, CAROLYN KAYE (MA ED CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:KAYE
Last Name:HURST
Suffix:
Gender:F
Credentials:MA ED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2113 HOT OAK RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-5519
Mailing Address - Country:US
Mailing Address - Phone:702-395-7818
Mailing Address - Fax:
Practice Address - Street 1:15272 W GABRIELA DR
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-6324
Practice Address - Country:US
Practice Address - Phone:623-523-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ SLP6094Q235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ235Z00000XMedicaid