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NPI Code Detail

MEDICARE: KATHERINE MARIE CARLOS MS

MEDICARE: KATHERINE MARIE CARLOS MS
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 Pathologist242006609IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1760151203
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE MARIE CARLOS MS
Provider Business Mailing Address
First Line : 3164 N CLARK ST APT G4
Second Line :
City : CHICAGO
State : IL
Zip : 60657-4475
Country : US
Telephone Number : 330-283-1612
Fax Number :
Provider Business Practice Location Address
First Line : 310 S MAIN ST STE D
Second Line :
City : LOMBARD
State : IL
Zip : 60148-2692
Country : US
Telephone Number : 630-652-0200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2021
Last Update Date : 09/08/2021

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Directions to “ KATHERINE MARIE CARLOS MS” Practice Location

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