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NPI Code Detail

MEDICARE: MRS. CAROL THERESA PERKINS

MEDICARE: MRS. CAROL THERESA PERKINS
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 PathologistSLPA6487AZ

General Provider Information

NPI Number : 1356673248
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CAROL THERESA PERKINS
Provider Business Mailing Address
First Line : 1954 DAYTONA AVE
Second Line :
City : LAKE HAVASU CITY
State : AZ
Zip : 86403-7418
Country : US
Telephone Number : 928-486-5214
Fax Number :
Provider Business Practice Location Address
First Line : 2200 HAVASUPAI BLVD
Second Line :
City : LAKE HAVASU CITY
State : AZ
Zip : 86403-3122
Country : US
Telephone Number : 928-505-6900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2010
Last Update Date : 02/03/2010

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Directions to “ MRS. CAROL THERESA PERKINS ” Practice Location

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