Provider Demographics
NPI:1548739584
Name:CARLSEN, KAMALA KAY (MS CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:KAMALA
Middle Name:KAY
Last Name:CARLSEN
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45800 KING DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20653-3317
Mailing Address - Country:US
Mailing Address - Phone:301-737-4824
Mailing Address - Fax:
Practice Address - Street 1:23160 MOAKLEY ST
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2922
Practice Address - Country:US
Practice Address - Phone:301-475-5511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03314235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist