MEDICARE: CARLON ANN EAGAN SPEECH PATHOLOGIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1548386568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLON ANN EAGAN SPEECH PATHOLOGIST

Provider Business Mailing Address
First Line	:	6810 HOLLOW HEARTH DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-1542
Country	:	US
Telephone Number	:	281-650-4635
Fax Number	:	832-427-1844

Provider Business Practice Location Address
First Line	:	6810 HOLLOW HEARTH DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-1542
Country	:	US
Telephone Number	:	281-650-4635
Fax Number	:	832-427-1844

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	07/08/2007

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