Provider Demographics
NPI:1851028153
Name:BUCIO, CARMELA ANN
Entity Type:Individual
Prefix:
First Name:CARMELA
Middle Name:ANN
Last Name:BUCIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARMELA
Other - Middle Name:ANN
Other - Last Name:CORONA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7200 SPRING CYPRESS RD
Mailing Address - Street 2:
Mailing Address - City:KLEIN
Mailing Address - State:TX
Mailing Address - Zip Code:77379-3215
Mailing Address - Country:US
Mailing Address - Phone:832-484-6018
Mailing Address - Fax:
Practice Address - Street 1:7200 SPRING CYPRESS RD
Practice Address - Street 2:
Practice Address - City:KLEIN
Practice Address - State:TX
Practice Address - Zip Code:77379-3215
Practice Address - Country:US
Practice Address - Phone:832-484-6018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109339235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3746547164Medicaid