Provider Demographics
NPI:1356087787
Name:CAROLINA COMMUNICATION AND DYSPHAGIA
Entity Type:Organization
Organization Name:CAROLINA COMMUNICATION AND DYSPHAGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SLP
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-578-8978
Mailing Address - Street 1:PO BOX 161
Mailing Address - Street 2:
Mailing Address - City:SCOTLAND NECK
Mailing Address - State:NC
Mailing Address - Zip Code:27874-0161
Mailing Address - Country:US
Mailing Address - Phone:252-578-8978
Mailing Address - Fax:
Practice Address - Street 1:192 LONG FARM RD
Practice Address - Street 2:
Practice Address - City:GARYSBURG
Practice Address - State:NC
Practice Address - Zip Code:27831-9750
Practice Address - Country:US
Practice Address - Phone:252-578-8978
Practice Address - Fax:252-541-2062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-09
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Multi-Specialty