MEDICARE: PAULA CARPENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TS0200X	School Psychologist

General Provider Information

NPI Number	:	1538641675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA CARPENTER

Provider Business Mailing Address
First Line	:	208 CAVELIER RD
Second Line	:
City	:	MARQUETTE HEIGHTS
State	:	IL
Zip	:	61554-1358
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	208 CAVELIER RD
Second Line	:
City	:	MARQUETTE HEIGHTS
State	:	IL
Zip	:	61554-1358
Country	:	US
Telephone Number	:	309-241-3365
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2018
Last Update Date	:	08/14/2024

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Directions to “ PAULA CARPENTER ” Practice Location

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