Provider Demographics
NPI:1750870382
Name:CARLSON, BREE N (MS CF-SLP)
Entity type:Individual
Prefix:
First Name:BREE
Middle Name:N
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 PIKE PL
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-4779
Mailing Address - Country:US
Mailing Address - Phone:815-674-2505
Mailing Address - Fax:
Practice Address - Street 1:1015 OCONOR AVE
Practice Address - Street 2:
Practice Address - City:LA SALLE
Practice Address - State:IL
Practice Address - Zip Code:61301-1216
Practice Address - Country:US
Practice Address - Phone:815-223-0303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.004482235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist