Provider Demographics
NPI:1205619087
Name:MCBRIDE CARLILE, REBEKAH (CCC-SLP)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:MCBRIDE CARLILE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:
Other - Last Name:CARLILE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:2124 PEMBROKE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-1218
Mailing Address - Country:US
Mailing Address - Phone:817-229-3826
Mailing Address - Fax:
Practice Address - Street 1:3509 HULEN ST STE 151
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6866
Practice Address - Country:US
Practice Address - Phone:817-989-6399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102361235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist