Provider Demographics
NPI:1508991712
Name:TRUSSELL, CAROL ANNE (AUD)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ANNE
Last Name:TRUSSELL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 DOUGLAS BLVD STE 992
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3639
Mailing Address - Country:US
Mailing Address - Phone:916-784-3500
Mailing Address - Fax:
Practice Address - Street 1:805 TWELVE BRIDGES DR STE 25
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-8811
Practice Address - Country:US
Practice Address - Phone:916-434-1110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1091231H00000X, 231HA2400X, 231H00000X
CAHA2422237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter