Provider Demographics
NPI:1316994767
Name:CARLSON, KORIE L (MS)
Entity type:Individual
Prefix:MRS
First Name:KORIE
Middle Name:L
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14828 PINE CONE TRL
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-7699
Mailing Address - Country:US
Mailing Address - Phone:352-243-1212
Mailing Address - Fax:
Practice Address - Street 1:235 CITRUS TOWER BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2712
Practice Address - Country:US
Practice Address - Phone:352-224-3121
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1078231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE5926YMedicare ID - Type UnspecifiedMEDICARE PROVIDER #
FLP36889Medicare UPIN