Basic Information
| Provider Information | |||||||||
| NPI: | 1033474887 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEYER | ||||||||
| FirstName: | CARLY | ||||||||
| MiddleName: | |||||||||
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| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6301 CAMPUS CIRCLE DR E | ||||||||
| Address2: | |||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750632712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4693740700 | ||||||||
| FaxNumber: | 8172492215 | ||||||||
| Practice Location | |||||||||
| Address1: | 6301 CAMPUS CIRCLE DR E | ||||||||
| Address2: | |||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750632712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4693740700 | ||||||||
| FaxNumber: | 8172492215 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2012 | ||||||||
| LastUpdateDate: | 08/29/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 107114 | TX | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.