Provider Demographics
NPI:1093907131
Name:KAULITZ, CAROLE A (MED CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CAROLE
Middle Name:A
Last Name:KAULITZ
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3407 NE 169TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-8618
Mailing Address - Country:US
Mailing Address - Phone:360-904-6626
Mailing Address - Fax:
Practice Address - Street 1:3407 NE 169TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-8618
Practice Address - Country:US
Practice Address - Phone:360-904-6626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00001258235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7125065Medicaid