Provider Demographics
NPI:1235913153
Name:BANWELL, CARLY KAY (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:KAY
Last Name:BANWELL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:KAY
Other - Last Name:BANWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CARLY KAY CROW
Mailing Address - Street 1:1720 ROUND ROCK ST
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-7443
Mailing Address - Country:US
Mailing Address - Phone:713-826-7724
Mailing Address - Fax:
Practice Address - Street 1:2104 PILGRIMS POINT DR
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-2329
Practice Address - Country:US
Practice Address - Phone:281-284-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101393235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist