Basic Information
Provider Information
NPI: 1437588209
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BUCHANAN
FirstName: CAROLYN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CCC-SLP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 57 REGIONAL DR
Address2: SUITE 7
City: CONCORD
State: NH
PostalCode: 033018518
CountryCode: US
TelephoneNumber: 6032262900
FaxNumber: 6032262907
Practice Location
Address1: 57 REGIONAL DR
Address2: SUITE 7
City: CONCORD
State: NH
PostalCode: 033018518
CountryCode: US
TelephoneNumber: 6032262900
FaxNumber: 6032262907
Other Information
ProviderEnumerationDate: 11/02/2013
LastUpdateDate: 11/04/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000X1511NHY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


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