Provider Demographics
NPI:1558613638
Name:AZOSE, CAROLE LYNN (MS)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:LYNN
Last Name:AZOSE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6023 OAKHURST RD S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-3044
Mailing Address - Country:US
Mailing Address - Phone:206-725-9094
Mailing Address - Fax:
Practice Address - Street 1:6023 OAKHURST RD S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-3044
Practice Address - Country:US
Practice Address - Phone:206-725-9094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00004049235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA235Z00000XMedicaid