Active NPI
Lael Irene Carlson
- Speech-Language Pathologist
- Oakland, CA
National Provider Identifier
1972864361
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 19826
- Practice address
- 150 Grand Ave
Oakland, CA 94612-3781 - Phone
- (510) 835-2131
- NPI assigned
- Jun 3, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 19826 | CA | Primary |
Addresses
Primary practice location
150 Grand Ave
Oakland, CA 94612-3781
Mailing address
104 Olive Ave
Piedmont, CA 94611-4430
Phone (510) 919-1063
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 94-3120231 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1338681600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1338681600000",
"number": "1972864361",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "104 OLIVE AVE",
"city": "PIEDMONT",
"state": "CA",
"postal_code": "946114430",
"telephone_number": "510-919-1063"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "150 GRAND AVE",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946123781",
"telephone_number": "510-835-2131"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARLSON",
"first_name": "LAEL",
"middle_name": "IRENE",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-06-03",
"last_updated": "2012-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "CA",
"license": "19826",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "94-3120231",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.