Provider Demographics
NPI:1124356795
Name:SPEECH 4 KIDZ
Entity Type:Organization
Organization Name:SPEECH 4 KIDZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:910-395-2995
Mailing Address - Street 1:5919 OLEANDER DR
Mailing Address - Street 2:#120
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4780
Mailing Address - Country:US
Mailing Address - Phone:910-395-2995
Mailing Address - Fax:
Practice Address - Street 1:5919 OLEANDER DR
Practice Address - Street 2:#120
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4780
Practice Address - Country:US
Practice Address - Phone:910-395-2995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023030650010OtherPENNSYLVANIA DEPT OF PUBLIC WELFARE MEDICAL ASSISTANCE PROVIDER