Provider Demographics
NPI:1457857112
Name:GIACO, CAROL ANNE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANNE
Last Name:GIACO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:ANNE
Other - Last Name:JUMPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:309 GOLD ST APT 12A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1280
Mailing Address - Country:US
Mailing Address - Phone:405-593-0414
Mailing Address - Fax:
Practice Address - Street 1:309 GOLD ST APT 12A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1280
Practice Address - Country:US
Practice Address - Phone:405-593-0414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKCF4854235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY028994OtherNYSED OFFICE OF THE PROFESSIONS
OKCF4854OtherOKLAHOMA BOARD OF EXAMINERS FOR SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY