Provider Demographics
NPI:1902161037
Name:WELBORN, CAROL ELIZABETH (SLP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ELIZABETH
Last Name:WELBORN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5007 W MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-4824
Mailing Address - Country:US
Mailing Address - Phone:903-466-6509
Mailing Address - Fax:903-759-6500
Practice Address - Street 1:5007 W MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-4824
Practice Address - Country:US
Practice Address - Phone:903-466-6509
Practice Address - Fax:903-759-6500
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-04
Last Update Date:2012-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107201235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist