Provider Demographics
NPI:1295248144
Name:VARGO, CAROL LYNN (CCC SLP/A)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:LYNN
Last Name:VARGO
Suffix:
Gender:F
Credentials:CCC SLP/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 THE CAPES BLVD
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-1464
Mailing Address - Country:US
Mailing Address - Phone:440-354-8716
Mailing Address - Fax:
Practice Address - Street 1:92 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-3224
Practice Address - Country:US
Practice Address - Phone:440-428-5121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6860235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist