Provider Demographics
NPI:1417331943
Name:FITZPATRICK GALLES, CAREY (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CAREY
Middle Name:
Last Name:FITZPATRICK GALLES
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:CAREY
Other - Middle Name:
Other - Last Name:GALLES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3005 KOKANEE TRL
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-6809
Mailing Address - Country:US
Mailing Address - Phone:916-708-8333
Mailing Address - Fax:
Practice Address - Street 1:3005 KOKANEE TRL
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-6809
Practice Address - Country:US
Practice Address - Phone:916-708-8333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13552235Z00000X
NV1463235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist