Provider Demographics
NPI:1255422218
Name:PEARCY, CAROL ANN (SLP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:PEARCY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:1315 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-4446
Mailing Address - Country:US
Mailing Address - Phone:903-794-2705
Mailing Address - Fax:
Practice Address - Street 1:1315 WALNUT ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-4446
Practice Address - Country:US
Practice Address - Phone:903-794-2705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR704235Z00000X
TX102234235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR122465721Medicaid
TX021289601Medicaid