Provider Demographics
NPI:1689895823
Name:BROSS, CARYN KELCY (MSCCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:CARYN
Middle Name:KELCY
Last Name:BROSS
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:MRS
Other - First Name:CARYN
Other - Middle Name:KELCY
Other - Last Name:BROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSCCCSLP
Mailing Address - Street 1:5253 MILLER AV
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206
Mailing Address - Country:US
Mailing Address - Phone:214-789-1377
Mailing Address - Fax:
Practice Address - Street 1:1922 CASTLE DRIVE
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040
Practice Address - Country:US
Practice Address - Phone:972-494-1471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101469235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist