Provider Demographics
NPI:1619231206
Name:CARRILLO, JULIE KRISITIE (MA CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:KRISITIE
Last Name:CARRILLO
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 1:15901 HAWTHORNE BLVD. #140.
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260
Mailing Address - Country:US
Mailing Address - Phone:424-257-1533
Mailing Address - Fax:310-370-2339
Practice Address - Street 1:15901 HAWTHORNE BLVD. #140.
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260
Practice Address - Country:US
Practice Address - Phone:424-257-1533
Practice Address - Fax:310-370-2339
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP18425235Z00000X
CASP 18425235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist