Provider Demographics
NPI:1235115510
Name:SOUTHEASTERN SPEECH INC
Entity Type:Organization
Organization Name:SOUTHEASTERN SPEECH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TARRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:910-735-1101
Mailing Address - Street 1:582C FARRINGDOM ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2615
Mailing Address - Country:US
Mailing Address - Phone:910-735-1101
Mailing Address - Fax:910-735-1103
Practice Address - Street 1:582C FARRINGDOM ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2615
Practice Address - Country:US
Practice Address - Phone:910-735-1101
Practice Address - Fax:910-735-1103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-19
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211460Medicaid