MEDICARE: CARLA MAE CULLISON

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	19717	TX

General Provider Information

NPI Number	:	1790265676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLA MAE CULLISON

Provider Business Mailing Address
First Line	:	8326 STONY CREEK DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-5817
Country	:	US
Telephone Number	:	214-680-8968
Fax Number	:

Provider Business Practice Location Address
First Line	:	8326 STONY CREEK DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-5817
Country	:	US
Telephone Number	:	214-680-8968
Fax Number	:

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

Provider Enumeration Date	:	08/20/2018
Last Update Date	:	08/20/2018

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Directions to “ CARLA MAE CULLISON ” Practice Location

Language	Start Address	Practice Location

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