Provider Demographics
NPI:1659564359
Name:CARR, CARRIE LEIANNE (MED, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:LEIANNE
Last Name:CARR
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 1:255 ELK DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-8692
Mailing Address - Country:US
Mailing Address - Phone:256-590-0787
Mailing Address - Fax:
Practice Address - Street 1:255 ELK DR
Practice Address - Street 2:SUITE B
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-8692
Practice Address - Country:US
Practice Address - Phone:256-590-0787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-26
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
12014033235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist