Provider Demographics
NPI:1720262868
Name:DUBIN, CAROL K (MS CCCSLP)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:K
Last Name:DUBIN
Suffix:
Gender:F
Credentials:MS CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9226 N PELHAM PKWY
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-1360
Mailing Address - Country:US
Mailing Address - Phone:414-352-9226
Mailing Address - Fax:
Practice Address - Street 1:9226 N PELHAM PKWY
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53217-1360
Practice Address - Country:US
Practice Address - Phone:414-352-9226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI371154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist