Provider Demographics
NPI:1295973709
Name:DESO, CAROLYN (MS CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:
Last Name:DESO
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 1:3949 WESTERN TPKE
Mailing Address - Street 2:
Mailing Address - City:ALTAMONT
Mailing Address - State:NY
Mailing Address - Zip Code:12009-5622
Mailing Address - Country:US
Mailing Address - Phone:518-477-6072
Mailing Address - Fax:518-477-6074
Practice Address - Street 1:2500 POND VW
Practice Address - Street 2:SUITE 102A
Practice Address - City:CASTLETON
Practice Address - State:NY
Practice Address - Zip Code:12033-9750
Practice Address - Country:US
Practice Address - Phone:518-477-6072
Practice Address - Fax:518-477-6074
Is Sole Proprietor?:No
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012827-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist