Provider Demographics
NPI:1033608963
Name:OAK CITY SPEECH AND LANGUAGE THERAPY, PLLC
Entity Type:Organization
Organization Name:OAK CITY SPEECH AND LANGUAGE THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SHELBY
Authorized Official - Middle Name:GAILE
Authorized Official - Last Name:POTTS
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:919-607-6264
Mailing Address - Street 1:105 COOKE ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27601-1121
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:919-336-1180
Practice Address - Street 1:105 COOKE ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27601-1121
Practice Address - Country:US
Practice Address - Phone:919-607-6264
Practice Address - Fax:919-336-1180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-07
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11831235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1326548587Medicaid