MEDICARE: CAROL S LETTKO MA 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	SP11949	CA

General Provider Information

NPI Number	:	1578160529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL S LETTKO MA CCC-SLP

Provider Business Mailing Address
First Line	:	1329 PELICAN WAY
Second Line	:
City	:	POINT RICHMOND
State	:	CA
Zip	:	94801-4114
Country	:	US
Telephone Number	:	925-285-0320
Fax Number	:

Provider Business Practice Location Address
First Line	:	1329 PELICAN WAY
Second Line	:
City	:	POINT RICHMOND
State	:	CA
Zip	:	94801-4114
Country	:	US
Telephone Number	:	925-285-0320
Fax Number	:

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

Provider Enumeration Date	:	10/02/2020
Last Update Date	:	10/02/2020

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Directions to “ CAROL S LETTKO MA CCC-SLP” Practice Location

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