Provider Demographics
NPI:1750535050
Name:FONTENETTE, CARRIE RYANNE (MS, CCC-SLP/L)
Entity type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:RYANNE
Last Name:FONTENETTE
Suffix:
Gender:F
Credentials:MS, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 MAE MDW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-4363
Mailing Address - Country:US
Mailing Address - Phone:315-730-6775
Mailing Address - Fax:
Practice Address - Street 1:1882 WINTON RD S STE 8
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3950
Practice Address - Country:US
Practice Address - Phone:585-697-1557
Practice Address - Fax:585-697-5692
Is Sole Proprietor?:No
Enumeration Date:2008-11-13
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018278235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1598065096OtherLIBERTY POST
NY1598996571OtherPARKSIDE CHILDREN'S CENTER
NY1609032937OtherINTERACTIVE THERAPY GROUP