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General NPI Number Information
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NPI Number | 1780461962
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Entity Type | Individual
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Provider Name | CAROLYN LOUISE CLERICO I MS,CCC,SLP
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Gender | Female
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Dates
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Enumeration Date | 09/12/2023
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Last Update Date | 09/12/2023
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Provider Practice Location Address
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Address Line | 1565 W MAIN ST
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City | LEWISVILLE
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State | TX
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Zip | 75067-3394
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Country | US
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Telephone | 469-713-5200
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Fax | 972-350-9500
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Provider Business Mailing Address
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Address Line | 16175 BARTON CREEK LN
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City | FRISCO
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State | TX
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Zip | 75033-5897
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Country | US
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Telephone | 214-543-1647
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 13862
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License Number State | AR
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