MEDICARE: MISS STEPHANIE ELIZABETH CARBO 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	SLP006730	GA

General Provider Information

NPI Number	:	1851628531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS STEPHANIE ELIZABETH CARBO CCC/SLP

Provider Business Mailing Address
First Line	:	441 BUCKINGHAM CIR
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30066-2503
Country	:	US
Telephone Number	:	225-573-2033
Fax Number	:

Provider Business Practice Location Address
First Line	:	441 BUCKINGHAM CIR
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30066-2503
Country	:	US
Telephone Number	:	225-573-2033
Fax Number	:

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

Provider Enumeration Date	:	11/17/2009
Last Update Date	:	11/17/2009

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Directions to “ MISS STEPHANIE ELIZABETH CARBO CCC/SLP” Practice Location

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