Provider Demographics
NPI:1033474887
Name:MEYER, CARLY (SLP)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:MEYER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 CAMPUS CIRCLE DR E
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-2712
Mailing Address - Country:US
Mailing Address - Phone:469-374-0700
Mailing Address - Fax:817-249-2215
Practice Address - Street 1:6301 CAMPUS CIRCLE DR E
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-2712
Practice Address - Country:US
Practice Address - Phone:469-374-0700
Practice Address - Fax:817-249-2215
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107114235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist