MEDICARE: MS. JANET ANTONESE CARULLI M.A. 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	SLP1863	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	707490	OTHER	AZ	AHCCCS
2	AZ0142730	OTHER	AZ	BCBS OF ARIZONA
3	SLP1863	OTHER	AZ	ARIZONA DEPT. OF HEALTH

General Provider Information

NPI Number	:	1134228026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANET ANTONESE CARULLI M.A. CCC/SLP

Provider Business Mailing Address
First Line	:	9348 E SYCAMORE SPRINGS TRL
Second Line	:
City	:	VAIL
State	:	AZ
Zip	:	85641-6516
Country	:	US
Telephone Number	:	520-404-9463
Fax Number	:

Provider Business Practice Location Address
First Line	:	9348 E SYCAMORE SPRINGS TRL
Second Line	:
City	:	VAIL
State	:	AZ
Zip	:	85641-6516
Country	:	US
Telephone Number	:	520-404-9463
Fax Number	:

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

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	07/08/2007

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