Provider Demographics
NPI:1043346679
Name:CARLBERG, CAROL
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:
Last Name:CARLBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8390 DELMAR BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-2117
Mailing Address - Country:US
Mailing Address - Phone:314-225-9768
Mailing Address - Fax:314-432-7503
Practice Address - Street 1:8390 DELMAR BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-2117
Practice Address - Country:US
Practice Address - Phone:314-225-9768
Practice Address - Fax:314-432-7503
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSPP02024235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist