Provider Demographics
NPI: | 1508991712 |
---|---|
Name: | TRUSSELL, CAROL ANNE (AUD) |
Entity Type: | Individual |
Prefix: | |
First Name: | CAROL |
Middle Name: | ANNE |
Last Name: | TRUSSELL |
Suffix: | |
Gender: | F |
Credentials: | AUD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 1850 DOUGLAS BLVD STE 992 |
Mailing Address - Street 2: | |
Mailing Address - City: | ROSEVILLE |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 95661-3639 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 916-784-3500 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 805 TWELVE BRIDGES DR STE 25 |
Practice Address - Street 2: | |
Practice Address - City: | LINCOLN |
Practice Address - State: | CA |
Practice Address - Zip Code: | 95648-8811 |
Practice Address - Country: | US |
Practice Address - Phone: | 916-434-1110 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-02-21 |
Last Update Date: | 2022-01-04 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | AU1091 | 231H00000X, 231HA2400X, 231H00000X |
CA | HA2422 | 237600000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 231H00000X | Speech, Language and Hearing Service Providers | Audiologist | |
No | 231HA2400X | Speech, Language and Hearing Service Providers | Audiologist | Assistive Technology Practitioner |
No | 237600000X | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |