Provider Demographics
NPI:1821830357
Name:CARPENTIER, CONNIE (SPEECH LANGUAGE PATH)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:CARPENTIER
Suffix:
Gender:F
Credentials:SPEECH LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2624 EL CAMINO REAL STE B
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1250
Mailing Address - Country:US
Mailing Address - Phone:760-363-3456
Mailing Address - Fax:760-696-3458
Practice Address - Street 1:2624 EL CAMINO REAL STE B
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1250
Practice Address - Country:US
Practice Address - Phone:760-363-3456
Practice Address - Fax:760-696-3458
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP8974235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist