Provider Demographics
NPI:1255002580
Name:JUNEBUG SPEECH AND LANGUAGE THERAPY, PLLC
Entity Type:Organization
Organization Name:JUNEBUG SPEECH AND LANGUAGE THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:EDYBURN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:984-202-8633
Mailing Address - Street 1:211 E SIX FORKS RD STE 219
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7755
Mailing Address - Country:US
Mailing Address - Phone:984-202-8633
Mailing Address - Fax:984-202-2098
Practice Address - Street 1:211 E SIX FORKS RD STE 219
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7755
Practice Address - Country:US
Practice Address - Phone:984-202-8633
Practice Address - Fax:984-202-2098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-27
Last Update Date:2022-12-21
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
NC1295319606Medicaid
NC1255002580Medicaid