Provider Demographics
NPI:1871127563
Name:IMLER, CARLY E (MS, CCC/SLP)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:E
Last Name:IMLER
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 SHOMONT DR
Mailing Address - Street 2:
Mailing Address - City:HARBORCREEK
Mailing Address - State:PA
Mailing Address - Zip Code:16421-1228
Mailing Address - Country:US
Mailing Address - Phone:814-602-0436
Mailing Address - Fax:814-520-5352
Practice Address - Street 1:275 SHOMONT DR
Practice Address - Street 2:
Practice Address - City:HARBORCREEK
Practice Address - State:PA
Practice Address - Zip Code:16421-1228
Practice Address - Country:US
Practice Address - Phone:814-602-0436
Practice Address - Fax:814-520-5352
Is Sole Proprietor?:No
Enumeration Date:2020-03-03
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL015018235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
14262144OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION
PASL015018OtherSTATE BOARD OF SPEECH PATHOLOGY AND AUDIOLOGY