Provider Demographics
NPI:1548068232
Name:CAMACHO, CARRIE (MS, CF-SLP)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:
Last Name:CAMACHO
Suffix:
Gender:
Credentials:MS, CF-SLP
Other - Prefix:MS
Other - First Name:CARRIE
Other - Middle Name:LYNN
Other - Last Name:DECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:N/A
Mailing Address - Street 1:1941 BOULTON WAY
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-3813
Mailing Address - Country:US
Mailing Address - Phone:510-213-4487
Mailing Address - Fax:
Practice Address - Street 1:1625 STOCKTON BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-7097
Practice Address - Country:US
Practice Address - Phone:510-213-4487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20284235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist