Provider Demographics
NPI:1316488174
Name:CARRILLO, VANESSA HOPE (MS CCC SLP)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:HOPE
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 E CHASE AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-6325
Mailing Address - Country:US
Mailing Address - Phone:619-647-6157
Mailing Address - Fax:
Practice Address - Street 1:260 E CHASE AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-6325
Practice Address - Country:US
Practice Address - Phone:619-647-6157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25135235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist