Provider Demographics
NPI:1164178893
Name:PLAYDATE SPEECH THERAPY
Entity Type:Organization
Organization Name:PLAYDATE SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:UMA
Authorized Official - Middle Name:
Authorized Official - Last Name:KALANI-GOSU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-912-4622
Mailing Address - Street 1:7904 WILBY HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-1824
Mailing Address - Country:US
Mailing Address - Phone:704-912-4622
Mailing Address - Fax:
Practice Address - Street 1:7904 WILBY HOLLOW DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-1824
Practice Address - Country:US
Practice Address - Phone:704-912-4622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UMA KALANI-GOSU
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1003950916Medicaid