Healthcare Provider Details

I. General information

NPI: 1740325059
Provider Name (Legal Business Name): CAROLYN I SOLBERG M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15802 N PARKVIEW PLACE
SURPRISE AZ
85374
US

IV. Provider business mailing address

12123 W BELL RD UNIT 101
SURPRISE AZ
85374-9617
US

V. Phone/Fax

Practice location:
  • Phone: 623-876-7000
  • Fax:
Mailing address:
  • Phone: 715-559-1633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP4909
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: