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General NPI Number Information
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NPI Number | 1891277331
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Entity Type | Individual
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Provider Name | CARLEY ELAINE THOMPSON
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Gender | Female
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Dates
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Enumeration Date | 08/31/2018
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Last Update Date | 08/15/2022
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Provider Practice Location Address
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Address Line | 215 NE 14TH ST
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City | FORT WORTH
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State | TX
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Zip | 76164-8901
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Country | US
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Telephone | 817-814-5400
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Fax |
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Provider Business Mailing Address
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Address Line | 2800 RYAN PLACE DR
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City | FORT WORTH
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State | TX
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Zip | 76110-3127
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Country | US
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Telephone | 678-457-6565
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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 | 114923
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License Number State | TX
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