MEDICARE: MS. CHRISTINE F CARROLL MA-CCC-SLP

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	102627	TX

General Provider Information

NPI Number	:	1366655391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHRISTINE F CARROLL MA-CCC-SLP

Provider Business Mailing Address
First Line	:	100 HORSESHOE DR
Second Line	:
City	:	KILGORE
State	:	TX
Zip	:	75662-2818
Country	:	US
Telephone Number	:	903-714-0795
Fax Number	:	903-988-7630

Provider Business Practice Location Address
First Line	:	144 FM 1252 WEST
Second Line	:
City	:	KILGORE
State	:	TX
Zip	:	75662-2818
Country	:	US
Telephone Number	:	903-988-1630
Fax Number	:	903-988-1630

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

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	07/08/2007

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Directions to “ MS. CHRISTINE F CARROLL MA-CCC-SLP” Practice Location

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