Provider Demographics
NPI:1912224007
Name:PICO, CAROL EDITH
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:EDITH
Last Name:PICO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1188 ROYAL GLEN DR
Mailing Address - Street 2:APT # 108
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-6099
Mailing Address - Country:US
Mailing Address - Phone:630-337-0509
Mailing Address - Fax:
Practice Address - Street 1:1188 ROYAL GLEN DR
Practice Address - Street 2:APT # 108
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-6099
Practice Address - Country:US
Practice Address - Phone:630-337-0509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter