Provider Demographics
NPI:1194802439
Name:CARNES, MARLA K (MS--SLP)
Entity type:Individual
Prefix:
First Name:MARLA
Middle Name:K
Last Name:CARNES
Suffix:
Gender:F
Credentials:MS--SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 KAREN DR
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-6935
Mailing Address - Country:US
Mailing Address - Phone:580-284-7408
Mailing Address - Fax:
Practice Address - Street 1:1216 KAREN DR
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-6935
Practice Address - Country:US
Practice Address - Phone:580-284-7408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102597235Z00000X
OK2393235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111408402Medicaid
TX87623TOtherBCBS OF TEXAS #
TX111408401Medicaid
TX111408402Medicaid