Provider Demographics
NPI:1760627335
Name:REPKO, CARLY L (MS CCC SLP)
Entity Type:Individual
Prefix:MS
First Name:CARLY
Middle Name:L
Last Name:REPKO
Suffix:
Gender:F
Credentials:MS CCC SLP
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Mailing Address - Street 1:100 SARATOGA VILLAGE BLVD
Mailing Address - Street 2:SUITE 35
Mailing Address - City:MALTA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-3737
Mailing Address - Country:US
Mailing Address - Phone:518-899-9235
Mailing Address - Fax:518-899-9315
Practice Address - Street 1:100 SARATOGA VILLAGE BLVD
Practice Address - Street 2:SUITE 35
Practice Address - City:MALTA
Practice Address - State:NY
Practice Address - Zip Code:12020-3737
Practice Address - Country:US
Practice Address - Phone:518-899-9235
Practice Address - Fax:518-899-9315
Is Sole Proprietor?:No
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY013464-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist