Basic Information
| Provider Information | |||||||||
| NPI: | 1184375883 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAROLLO | ||||||||
| FirstName: | KATELIN | ||||||||
| MiddleName: | ROSE | ||||||||
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| Credential: | M.S., CF-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1846 REDWOOD DR | ||||||||
| Address2: | |||||||||
| City: | APTOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950032513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8312473370 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 24600 SILVER CLOUD CT STE 104 | ||||||||
| Address2: | |||||||||
| City: | MONTEREY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939406555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316457900 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2022 | ||||||||
| LastUpdateDate: | 01/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.