Provider Demographics
NPI:1366655391
Name:CARROLL, CHRISTINE F (MA-CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:F
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MA-CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HORSESHOE DR
Mailing Address - Street 2:
Mailing Address - City:KILGORE
Mailing Address - State:TX
Mailing Address - Zip Code:75662-2818
Mailing Address - Country:US
Mailing Address - Phone:903-714-0795
Mailing Address - Fax:903-988-7630
Practice Address - Street 1:144 FM 1252 WEST
Practice Address - Street 2:
Practice Address - City:KILGORE
Practice Address - State:TX
Practice Address - Zip Code:75662-2818
Practice Address - Country:US
Practice Address - Phone:903-988-1630
Practice Address - Fax:903-988-1630
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102627235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist