Provider Demographics
NPI:1790045730
Name:TAUB, CARRIE DAVIS
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:DAVIS
Last Name:TAUB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:BOWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:107 WOODBINE PL UNIT 775
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-2912
Mailing Address - Country:US
Mailing Address - Phone:903-757-8194
Mailing Address - Fax:903-757-8294
Practice Address - Street 1:107 WOODBINE PL UNIT 775
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-2912
Practice Address - Country:US
Practice Address - Phone:037-578-1949
Practice Address - Fax:903-757-8294
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16416235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist