Provider Demographics
NPI:1255328167
Name:EKLUND, TAMI H (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TAMI
Middle Name:H
Last Name:EKLUND
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WADE HAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28104-6376
Mailing Address - Country:US
Mailing Address - Phone:704-995-1465
Mailing Address - Fax:704-283-6181
Practice Address - Street 1:200 WADE HAMPTON DR
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28104-6376
Practice Address - Country:US
Practice Address - Phone:704-995-1465
Practice Address - Fax:704-283-6181
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2125235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7411970Medicaid
SCSAN042Medicaid