Provider Demographics
NPI:1942713920
Name:CARLIN, ALISA ANNE-MARIE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:ANNE-MARIE
Last Name:CARLIN
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 1:25043 GATES LN
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-2191
Mailing Address - Country:US
Mailing Address - Phone:815-483-3347
Mailing Address - Fax:
Practice Address - Street 1:780 SHORELINE DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-6192
Practice Address - Country:US
Practice Address - Phone:630-375-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146005841235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1245360239Medicaid