Provider Demographics
NPI:1164653358
Name:SPEECH & LANGUAGE PATHOLOGY OF DE AMERICAS
Entity Type:Organization
Organization Name:SPEECH & LANGUAGE PATHOLOGY OF DE AMERICAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:TANI
Authorized Official - Middle Name:C
Authorized Official - Last Name:OSORIO
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:910-551-3337
Mailing Address - Street 1:520 SOUTHWICK DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-2641
Mailing Address - Country:US
Mailing Address - Phone:910-551-3337
Mailing Address - Fax:910-864-2705
Practice Address - Street 1:106 HAY ST
Practice Address - Street 2:SUITE 212
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5650
Practice Address - Country:US
Practice Address - Phone:910-551-3337
Practice Address - Fax:910-864-2705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7846235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty