Provider Demographics
NPI:1518635820
Name:EKSTROM, CAROL
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:EKSTROM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:BITTINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, MA CCC-SLP
Mailing Address - Street 1:4130 MATHER
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-9208
Mailing Address - Country:US
Mailing Address - Phone:860-752-8508
Mailing Address - Fax:
Practice Address - Street 1:500 BLANCO ST
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-8012
Practice Address - Country:US
Practice Address - Phone:512-268-4688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114820235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist