Provider Demographics
NPI:1003552449
Name:CARROLL, SHELLY DIANE (SLP-ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:DIANE
Last Name:CARROLL
Suffix:
Gender:F
Credentials:SLP-ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 MASQUERADE DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-8882
Mailing Address - Country:US
Mailing Address - Phone:817-658-3990
Mailing Address - Fax:
Practice Address - Street 1:605 E BROAD ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-1794
Practice Address - Country:US
Practice Address - Phone:817-299-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX327582355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant