Provider Demographics
NPI:1295933851
Name:RECTOR, CAROLYN BLACK (MS CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:BLACK
Last Name:RECTOR
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:MARIE
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9009 GREAT HILLS TRL APT 1321
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-7143
Mailing Address - Country:US
Mailing Address - Phone:308-991-5741
Mailing Address - Fax:
Practice Address - Street 1:121 FM 971
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-4546
Practice Address - Country:US
Practice Address - Phone:512-868-6214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103462235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist