Provider Demographics
NPI:1225478324
Name:PATH SPEECH THERAPY
Entity Type:Organization
Organization Name:PATH SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TAGGART
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:919-901-7260
Mailing Address - Street 1:221 W HILL ST
Mailing Address - Street 2:PO BOX 916
Mailing Address - City:BENSON
Mailing Address - State:NC
Mailing Address - Zip Code:27504-1133
Mailing Address - Country:US
Mailing Address - Phone:919-901-7260
Mailing Address - Fax:919-207-2121
Practice Address - Street 1:221 WEST HILL STREET
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:NC
Practice Address - Zip Code:27504-8901
Practice Address - Country:US
Practice Address - Phone:919-901-7260
Practice Address - Fax:919-207-2121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-03
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5820235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty