Individual
MRS. ALYCIA LEANE CARROLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
1605 E OAKLAND AVE, BLOOMINGTON, IL 61701-5617
(309) 662-4302
Mailing address
1106 IRONWOOD CC DR, NORMAL, IL 61761-5233
(309) 706-3044
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146009500
IL
Other
Enumeration date
08/21/2018
Last updated
08/21/2018
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