Provider Demographics
NPI:1376278887
Name:WOODLE, CHARLA K (MED CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHARLA
Middle Name:K
Last Name:WOODLE
Suffix:
Gender:F
Credentials:MED CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1862 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:SEALY
Mailing Address - State:TX
Mailing Address - Zip Code:77474-8643
Mailing Address - Country:US
Mailing Address - Phone:281-844-3633
Mailing Address - Fax:
Practice Address - Street 1:2214 WALLER ST
Practice Address - Street 2:
Practice Address - City:WALLER
Practice Address - State:TX
Practice Address - Zip Code:77484-8461
Practice Address - Country:US
Practice Address - Phone:281-844-3633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15619235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist