Provider Demographics
NPI:1003227695
Name:PACILEO, CARLA JEAN (SLP)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:JEAN
Last Name:PACILEO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3253 WARREN SHARON RD
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44473-9531
Mailing Address - Country:US
Mailing Address - Phone:330-856-7570
Mailing Address - Fax:
Practice Address - Street 1:3306 RIDGE RD
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-9420
Practice Address - Country:US
Practice Address - Phone:330-856-7570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist