Provider Demographics
NPI:1780461962
Name:CLERICO, CAROLYN LOUISE I (MS,CCC,SLP)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:LOUISE
Last Name:CLERICO
Suffix:I
Gender:F
Credentials:MS,CCC,SLP
Other - Prefix:MS
Other - First Name:CAROLYN
Other - Middle Name:LOUISE
Other - Last Name:CLERICO
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:MS,CCC,SLP
Mailing Address - Street 1:16175 BARTON CREEK LN
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-5897
Mailing Address - Country:US
Mailing Address - Phone:214-543-1647
Mailing Address - Fax:
Practice Address - Street 1:1565 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3394
Practice Address - Country:US
Practice Address - Phone:469-713-5200
Practice Address - Fax:972-350-9500
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR13862235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist