Provider Demographics
NPI:1447398342
Name:CARY, JOY CARTER (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:CARTER
Last Name:CARY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:JOY
Other - Last Name:CARY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3604 SKYLINE BLVD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-1435
Mailing Address - Country:US
Mailing Address - Phone:972-345-2565
Mailing Address - Fax:
Practice Address - Street 1:3604 SKYLINE BLVD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-1435
Practice Address - Country:US
Practice Address - Phone:972-345-2565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18927235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX189057721Medicaid
TX8T6873OtherBCBS PROVIDER NUMBER