Provider Demographics
NPI:1043853195
Name:DURHAM SPEECH PATHOLOGY
Entity Type:Organization
Organization Name:DURHAM SPEECH PATHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMELLE
Authorized Official - Middle Name:E
Authorized Official - Last Name:SALOMON
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:919-210-2683
Mailing Address - Street 1:507 NOVEMBER DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712-2444
Mailing Address - Country:US
Mailing Address - Phone:919-210-2683
Mailing Address - Fax:
Practice Address - Street 1:507 NOVEMBER DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27712-2444
Practice Address - Country:US
Practice Address - Phone:919-210-2683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty