Provider Demographics
NPI:1548033756
Name:CARROLL, KIERSTEN R
Entity type:Individual
Prefix:
First Name:KIERSTEN
Middle Name:R
Last Name:CARROLL
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 1:3721 GOLDENROD AVE
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74604-4602
Mailing Address - Country:US
Mailing Address - Phone:580-491-2442
Mailing Address - Fax:
Practice Address - Street 1:3721 GOLDENROD AVE
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74604-4602
Practice Address - Country:US
Practice Address - Phone:580-491-2442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-31
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant