Provider Demographics
NPI:1942423157
Name:STOLTENBERG, CARLY RENEE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CARLY
Middle Name:RENEE
Last Name:STOLTENBERG
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 1:208 N COTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-9304
Mailing Address - Country:US
Mailing Address - Phone:480-980-7936
Mailing Address - Fax:
Practice Address - Street 1:208 N COTTONWOOD DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-9304
Practice Address - Country:US
Practice Address - Phone:480-980-7936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP0792235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist