Provider Demographics
NPI:1033556055
Name:ALVARADO, CARLOS IVAN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:IVAN
Last Name:ALVARADO
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3556 ASHFORD DUNWOODY RD NE APT E
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319-5049
Mailing Address - Country:US
Mailing Address - Phone:404-783-9974
Mailing Address - Fax:
Practice Address - Street 1:3556 ASHFORD DUNWOODY RD NE APT E
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30319-5049
Practice Address - Country:US
Practice Address - Phone:404-783-9974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-31
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007768235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist