Provider Demographics
NPI:1235206848
Name:HULSEY SPEECH PATHOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:HULSEY SPEECH PATHOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:TANNER
Authorized Official - Last Name:HULSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:910-257-2005
Mailing Address - Street 1:519 BEAUMONT RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4424
Mailing Address - Country:US
Mailing Address - Phone:910-257-2005
Mailing Address - Fax:910-485-6315
Practice Address - Street 1:519 BEAUMONT RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4424
Practice Address - Country:US
Practice Address - Phone:910-257-2005
Practice Address - Fax:910-485-6315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6003235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211750Medicaid