Healthcare Provider Details

I. General information

NPI: 1134228026
Provider Name (Legal Business Name): JANET ANTONESE CARULLI M.A. CCC/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9348 E SYCAMORE SPRINGS TRL
VAIL AZ
85641-6516
US

IV. Provider business mailing address

9348 E SYCAMORE SPRINGS TRL
VAIL AZ
85641-6516
US

V. Phone/Fax

Practice location:
  • Phone: 520-404-9463
  • Fax:
Mailing address:
  • Phone: 520-404-9463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP1863
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: