Provider Demographics
NPI:1194483743
Name:BUNN, CARRIE ELIZABETH (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:ELIZABETH
Last Name:BUNN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14651 DALLAS PKWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-7476
Mailing Address - Country:US
Mailing Address - Phone:214-575-2999
Mailing Address - Fax:
Practice Address - Street 1:14651 DALLAS PKWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-7476
Practice Address - Country:US
Practice Address - Phone:214-575-2999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0003389Medicaid