Provider Demographics
NPI:1356449433
Name:CARBONARA, ERIN LYNN JOBE (MA CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:LYNN JOBE
Last Name:CARBONARA
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
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Mailing Address - Street 1:2037 W CUYLER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3005
Mailing Address - Country:US
Mailing Address - Phone:773-919-9181
Mailing Address - Fax:773-337-4987
Practice Address - Street 1:2037 WEST CUYLER AVENUE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3049
Practice Address - Country:US
Practice Address - Phone:773-919-9181
Practice Address - Fax:773-337-4987
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL146.008469235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist