Individual
MRS. NICOLE CARRILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC
Contact information
Practice address
640 NW JEFFERSON ST, GRAIN VALLEY, MO 64029-8278
(816) 785-2284
(816) 633-4371
Mailing address
701 OPERA HOUSE LN, ODESSA, MO 64076-1624
(816) 785-2284
(816) 633-4371
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2013013585
MO
Other
Enumeration date
12/28/2013
Last updated
12/28/2013
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