Provider Demographics
NPI:1437499134
Name:CARBOL, PATTI ANN (MSCCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:PATTI
Middle Name:ANN
Last Name:CARBOL
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1948 BEACONGROVE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-3637
Mailing Address - Country:US
Mailing Address - Phone:314-542-2067
Mailing Address - Fax:
Practice Address - Street 1:850 COUNTRY MANOR LN
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6651
Practice Address - Country:US
Practice Address - Phone:314-434-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-18
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01151235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist