Healthcare Provider Details

I. General information

NPI: 1255422218
Provider Name (Legal Business Name): CAROL ANN PEARCY SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAROL ANN WOOD SLP

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 10/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 WALNUT ST
TEXARKANA TX
75501-4446
US

IV. Provider business mailing address

1315 WALNUT ST
TEXARKANA TX
75501-4446
US

V. Phone/Fax

Practice location:
  • Phone: 903-794-2705
  • Fax:
Mailing address:
  • Phone: 903-794-2705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number704
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number102234
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: