Provider Demographics
NPI:1134611767
Name:CAROLLO, LEA (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LEA
Middle Name:
Last Name:CAROLLO
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 195TH ST SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-7099
Mailing Address - Country:US
Mailing Address - Phone:916-849-1511
Mailing Address - Fax:
Practice Address - Street 1:632 195TH ST SE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-7099
Practice Address - Country:US
Practice Address - Phone:916-849-1511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist