Healthcare Provider Details

I. General information

NPI: 1891923231
Provider Name (Legal Business Name): AJA CARRILLO SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AJA A WHATLEY MS SLP

II. Dates (important events)

Enumeration Date: 06/24/2009
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7552 NAVARRE PKWY UNIT 47
NAVARRE FL
32566-7309
US

IV. Provider business mailing address

1621 POINT PARK DR
JOHNS ISLAND SC
29455-7650
US

V. Phone/Fax

Practice location:
  • Phone: 831-309-2101
  • Fax: 877-215-7951
Mailing address:
  • Phone: 831-309-2101
  • Fax: 877-215-7951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number32410
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP.8344
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA10343
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: