Provider Demographics
NPI:1538288519
Name:CARROLL, BEVERLY (SLP)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:CARROLL
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 1:11920 WALTERS RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77067-1956
Mailing Address - Country:US
Mailing Address - Phone:713-696-3131
Mailing Address - Fax:713-696-2133
Practice Address - Street 1:11920 WALTERS RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77067-1956
Practice Address - Country:US
Practice Address - Phone:713-696-3131
Practice Address - Fax:713-696-2133
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16971235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX089368703Medicaid