Provider Demographics
NPI:1619280898
Name:WILSON, CARRIE WOODS (MED, SLP)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:WOODS
Last Name:WILSON
Suffix:
Gender:F
Credentials:MED, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 GOLDEN GATE DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-5067
Mailing Address - Country:US
Mailing Address - Phone:972-245-5562
Mailing Address - Fax:
Practice Address - Street 1:1501 GOLDEN GATE DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-5067
Practice Address - Country:US
Practice Address - Phone:972-245-5562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18270235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist