Provider Demographics
NPI:1093965972
Name:BK COMMUNICATIONS SPEECH THERAPY SERVICE,INC
Entity Type:Organization
Organization Name:BK COMMUNICATIONS SPEECH THERAPY SERVICE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TEKEITHA
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:704-577-8187
Mailing Address - Street 1:12021 CHEVIOTT HILL LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-3895
Mailing Address - Country:US
Mailing Address - Phone:704-577-8187
Mailing Address - Fax:704-455-5942
Practice Address - Street 1:12021 CHEVIOTT HILL LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-3895
Practice Address - Country:US
Practice Address - Phone:704-577-8187
Practice Address - Fax:704-455-5942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5666235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412523Medicaid