Provider Demographics
NPI:1578653903
Name:KING, CARMELITA (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CARMELITA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3029 N HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-1638
Mailing Address - Country:US
Mailing Address - Phone:847-253-4841
Mailing Address - Fax:
Practice Address - Street 1:165 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:SUITE 170
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1783
Practice Address - Country:US
Practice Address - Phone:847-459-4190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist