Provider Demographics
NPI:1265019699
Name:TEACH SPEECH
Entity Type:Organization
Organization Name:TEACH SPEECH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KACY
Authorized Official - Middle Name:
Authorized Official - Last Name:WICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-258-7031
Mailing Address - Street 1:11112 SCRIMSHAW LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-8304
Mailing Address - Country:US
Mailing Address - Phone:704-258-7031
Mailing Address - Fax:
Practice Address - Street 1:11112 SCRIMSHAW LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-8304
Practice Address - Country:US
Practice Address - Phone:704-258-7031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-24
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty