Provider Demographics
NPI:1558044198
Name:TRUJILLO, CARRIE JEANNE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:JEANNE
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 HARRISON RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-3586
Mailing Address - Country:US
Mailing Address - Phone:719-579-2801
Mailing Address - Fax:
Practice Address - Street 1:1060 HARRISON RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-3543
Practice Address - Country:US
Practice Address - Phone:719-579-2801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO377879235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist