MEDICARE: CARLOS IVAN ALVARADO 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	SLP007768	GA

General Provider Information

NPI Number	:	1033556055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS IVAN ALVARADO CCC-SLP

Provider Business Mailing Address
First Line	:	3556 ASHFORD DUNWOODY RD NE APT E
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30319-5049
Country	:	US
Telephone Number	:	404-783-9974
Fax Number	:

Provider Business Practice Location Address
First Line	:	3556 ASHFORD DUNWOODY RD NE APT E
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30319-5049
Country	:	US
Telephone Number	:	404-783-9974
Fax Number	:

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

Provider Enumeration Date	:	05/31/2013
Last Update Date	:	05/31/2013

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Directions to “ CARLOS IVAN ALVARADO CCC-SLP” Practice Location

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