Basic Information
| Provider Information | |||||||||
| NPI: | 1629349121 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BANKS | ||||||||
| FirstName: | CAROLYN | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 299 W HILLCREST DR | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | THOUSAND OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913604264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8052934222 | ||||||||
| FaxNumber: | 8055838064 | ||||||||
| Practice Location | |||||||||
| Address1: | 299 W HILLCREST DR | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | THOUSAND OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913604264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8052934222 | ||||||||
| FaxNumber: | 8055838064 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2012 | ||||||||
| LastUpdateDate: | 01/16/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 5424 | CA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.