Provider Demographics
NPI:1053757443
Name:PELLEGRINO, CAROLINE M (SLP)
Entity type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:M
Last Name:PELLEGRINO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 D WATERVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02917-1787
Mailing Address - Country:US
Mailing Address - Phone:401-263-1681
Mailing Address - Fax:
Practice Address - Street 1:2090 WALLUM LAKE RD.
Practice Address - Street 2:
Practice Address - City:PASCOAG
Practice Address - State:RI
Practice Address - Zip Code:02859-1813
Practice Address - Country:US
Practice Address - Phone:401-567-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-13
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP00986235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist