Provider Demographics
NPI:1134322399
Name:FELLERS, CAROL ELISABETH (MA CCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ELISABETH
Last Name:FELLERS
Suffix:
Gender:F
Credentials:MA CCCSLP
Other - Prefix:MISS
Other - First Name:CAROL
Other - Middle Name:ELISABETH
Other - Last Name:CAREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCCSLP
Mailing Address - Street 1:824 W FIGUEROA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-4807
Mailing Address - Country:US
Mailing Address - Phone:805-564-1976
Mailing Address - Fax:
Practice Address - Street 1:191 WEST BURTON MESA BLVD
Practice Address - Street 2:STE B
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436
Practice Address - Country:US
Practice Address - Phone:805-733-4542
Practice Address - Fax:805-733-4392
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0663623OtherTRIWEST
CAGSP000390Medicaid
CA0663623OtherTRIWEST