Provider Demographics
NPI:1871897892
Name:TITLOW, CARRIE MARIE (MA)
Entity type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:MARIE
Last Name:TITLOW
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 GORHAM ST
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1804
Mailing Address - Country:US
Mailing Address - Phone:585-396-0057
Mailing Address - Fax:
Practice Address - Street 1:151 HYDE PKWY
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:NY
Practice Address - Zip Code:14522-1235
Practice Address - Country:US
Practice Address - Phone:315-597-3420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020266-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist