MEDICARE: CARRIE CHOUINARD

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	15095	CA

General Provider Information

NPI Number	:	1003436643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE CHOUINARD

Provider Business Mailing Address
First Line	:	7836 MISSION MONTANA PL
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-1543
Country	:	US
Telephone Number	:	619-347-5971
Fax Number	:

Provider Business Practice Location Address
First Line	:	7836 MISSION MONTANA PL
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-1543
Country	:	US
Telephone Number	:	619-347-5971
Fax Number	:

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

Provider Enumeration Date	:	04/23/2020
Last Update Date	:	04/23/2020

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Directions to “ CARRIE CHOUINARD ” Practice Location

Language	Start Address	Practice Location

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