1053757443 NPI number — MS. CAROLINE M. PELLEGRINO SLP

Table of content: MRS. SEPIDEH A KOHN L.AC (NPI 1639412711)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053757443 NPI number — MS. CAROLINE M. PELLEGRINO SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PELLEGRINO
Provider First Name:
CAROLINE
Provider Middle Name:
M.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053757443
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
34 D WATERVIEW DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SMITHFIELD
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02917-1787
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-263-1681
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2090 WALLUM LAKE RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASCOAG
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02859-1813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-567-5400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/13/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SP00986 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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