Provider Demographics
NPI:1215179098
Name:BRESTLIN-KLINE, CAROLYN (CCC/SLP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:BRESTLIN-KLINE
Suffix:
Gender:F
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 1:100 WADE ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-2101
Mailing Address - Country:US
Mailing Address - Phone:917-699-4169
Mailing Address - Fax:
Practice Address - Street 1:100 WADE ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-2101
Practice Address - Country:US
Practice Address - Phone:917-699-4169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0107181235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist