Provider Demographics
NPI:1609504653
Name:CARLTON, LISETTE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LISETTE
Middle Name:
Last Name:CARLTON
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 1:10827 CLEARBROOK LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-1806
Mailing Address - Country:US
Mailing Address - Phone:432-466-9000
Mailing Address - Fax:
Practice Address - Street 1:2232 SUSSEX DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-1415
Practice Address - Country:US
Practice Address - Phone:972-926-2640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101037235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty