Provider Demographics
NPI:1700397262
Name:FITZGIBBONS, CARMA (SLP)
Entity Type:Individual
Prefix:MRS
First Name:CARMA
Middle Name:
Last Name:FITZGIBBONS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:CARMA
Other - Middle Name:
Other - Last Name:ROTHHAMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:3007 CREEK HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-6469
Mailing Address - Country:US
Mailing Address - Phone:972-977-2229
Mailing Address - Fax:
Practice Address - Street 1:4300 SIGMA RD STE 130
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-4445
Practice Address - Country:US
Practice Address - Phone:972-756-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16094235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist