Provider Demographics
NPI:1306840251
Name:SPEECHCENTER, INC.
Entity Type:Organization
Organization Name:SPEECHCENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, COO
Authorized Official - Prefix:MS
Authorized Official - First Name:JERI
Authorized Official - Middle Name:L
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-725-0222
Mailing Address - Street 1:185 CHARLOIS BLVD.
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1521
Mailing Address - Country:US
Mailing Address - Phone:336-725-0222
Mailing Address - Fax:336-725-0454
Practice Address - Street 1:185 CHARLOIS BLVD.
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-1521
Practice Address - Country:US
Practice Address - Phone:336-725-0222
Practice Address - Fax:336-725-0454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2012-08-16
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
NC740272CMedicaid
NC0272COtherBLUE CROSS BLUE SHIELD NC