Provider Demographics
NPI:1366728149
Name:CARTER, MARCIA DESHAZO (CCC,SLP)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:DESHAZO
Last Name:CARTER
Suffix:
Gender:F
Credentials:CCC,SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3496 MAZANEC RD
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76705-6119
Mailing Address - Country:US
Mailing Address - Phone:254-722-1879
Mailing Address - Fax:254-235-7604
Practice Address - Street 1:6610 N. IH 35
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76705
Practice Address - Country:US
Practice Address - Phone:254-722-1879
Practice Address - Fax:254-235-7612
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16305235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist