Provider Demographics
NPI:1851628531
Name:CARBO, STEPHANIE ELIZABETH (CCC/SLP)
Entity Type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:ELIZABETH
Last Name:CARBO
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 1:441 BUCKINGHAM CIR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-2503
Mailing Address - Country:US
Mailing Address - Phone:225-573-2033
Mailing Address - Fax:
Practice Address - Street 1:441 BUCKINGHAM CIR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-2503
Practice Address - Country:US
Practice Address - Phone:225-573-2033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006730235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist