Basic Information
| Provider Information | |||||||||
| NPI: | 1871125997 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAROLINA KIDZ THERAPY, LLC | ||||||||
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| Address1: | 5516 FENWAY DR | ||||||||
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| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282733976 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047850560 | ||||||||
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| Address1: | 5516 FENWAY DR | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282733976 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047850560 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2020 | ||||||||
| LastUpdateDate: | 02/06/2020 | ||||||||
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| AuthorizedOfficialLastName: | DICARLO | ||||||||
| AuthorizedOfficialFirstName: | PAMELA | ||||||||
| AuthorizedOfficialMiddleName: | MECHELE | ||||||||
| AuthorizedOfficialTitleorPosition: | SPEECH-LANGUAGE PATHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 4128498209 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | M.S. CCC-SLP | ||||||||
| NPICertificationDate: | 02/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.