MEDICARE: KAROLIE S LEROW CCC-SLP

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	235Z00000X	Speech-Language Pathologist	9257	NC

General Provider Information

NPI Number	:	1740580372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAROLIE S LEROW CCC-SLP

Provider Business Mailing Address
First Line	:	2112 COLONY PLZ
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-1605
Country	:	US
Telephone Number	:	910-388-2411
Fax Number	:	910-388-2411

Provider Business Practice Location Address
First Line	:	2112 COLONY PLZ
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-1605
Country	:	US
Telephone Number	:	910-388-2411
Fax Number	:	910-388-2411

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

Provider Enumeration Date	:	10/29/2010
Last Update Date	:	10/29/2010

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Directions to “ KAROLIE S LEROW CCC-SLP” Practice Location

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