Provider Demographics
NPI:1134228026
Name:CARULLI, JANET ANTONESE (MA CCC/SLP)
Entity type:Individual
Prefix:MS
First Name:JANET
Middle Name:ANTONESE
Last Name:CARULLI
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 1:9348 E SYCAMORE SPRINGS TRL
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:AZ
Mailing Address - Zip Code:85641-6516
Mailing Address - Country:US
Mailing Address - Phone:520-404-9463
Mailing Address - Fax:
Practice Address - Street 1:9348 E SYCAMORE SPRINGS TRL
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:AZ
Practice Address - Zip Code:85641-6516
Practice Address - Country:US
Practice Address - Phone:520-404-9463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP1863235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ707490OtherAHCCCS
AZAZ0142730OtherBCBS OF ARIZONA
AZSLP1863OtherARIZONA DEPT. OF HEALTH