Provider Demographics
NPI:1629134572
Name:ISAAC, CHARLETHA CARR (MSCCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:CHARLETHA
Middle Name:CARR
Last Name:ISAAC
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 N WELLSFORD DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7625
Mailing Address - Country:US
Mailing Address - Phone:713-703-1057
Mailing Address - Fax:281-412-2651
Practice Address - Street 1:11200 BROADWAY ST
Practice Address - Street 2:#2743
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-9785
Practice Address - Country:US
Practice Address - Phone:713-703-1057
Practice Address - Fax:281-412-2651
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101281235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202138801Medicaid