1780461962 NPI number — CAROLYN LOUISE CLERICO I MS,CCC,SLP

Table of content: CAROLYN LOUISE CLERICO I MS,CCC,SLP (NPI 1780461962)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780461962 NPI number — CAROLYN LOUISE CLERICO I MS,CCC,SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLERICO
Provider First Name:
CAROLYN
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
Provider Name Suffix Text:
I
Provider Credential Text:
MS,CCC,SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CLERICO
Provider Other First Name:
CAROLYN
Provider Other Middle Name:
LOUISE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
I
Provider Other Credential Text:
MS,CCC,SLP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1780461962
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16175 BARTON CREEK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRISCO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75033-5897
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-543-1647
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1565 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75067-3394
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-713-5200
Provider Business Practice Location Address Fax Number:
972-350-9500
Provider Enumeration Date:
09/12/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  13862 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com