=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225909336
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KARSYN DANIELLE WILEY SLP-A
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2025
-----------------------------------------------------
Last Update Date | 09/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7929 BROOKRIVER DR STE 700
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75247-4950
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-838-7975
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2915 BURNEY LN
-----------------------------------------------------
City | SOUTHLAKE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76092-2705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-242-2355
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2355S0801X
-----------------------------------------------------
Taxonomy Name | Speech-Language Assistant
-----------------------------------------------------
License Number | 44560
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------