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NPI Code Detail

MEDICARE: MRS. BREANNE CARRO M.S., CCC-SLP

MEDICARE: MRS. BREANNE CARRO M.S., 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
1235Z00000XSpeech-Language Pathologist242001542IL

General Provider Information

NPI Number : 1174835607
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BREANNE CARRO M.S., CCC-SLP
Provider Business Mailing Address
First Line : 1657 W CORTLAND ST
Second Line :
City : CHICAGO
State : IL
Zip : 60622-1119
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1657 W CORTLAND ST
Second Line :
City : CHICAGO
State : IL
Zip : 60622-1119
Country : US
Telephone Number : 877-486-4140
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2010
Last Update Date : 12/01/2014

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Directions to “ MRS. BREANNE CARRO M.S., CCC-SLP” Practice Location

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