Provider Demographics
NPI:1548930894
Name:BARBON, CARLY ELENA ANTOINETTE (PHD)
Entity type:Individual
Prefix:DR
First Name:CARLY
Middle Name:ELENA ANTOINETTE
Last Name:BARBON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 DUNLAVY ST APT 256
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-5297
Mailing Address - Country:US
Mailing Address - Phone:832-208-2004
Mailing Address - Fax:
Practice Address - Street 1:1515 HOLCOMBE BLVD.
Practice Address - Street 2:HEAD & NECK CENTER, 10TH FL MAIN BUILDING
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:832-208-2004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118967235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist