Provider Demographics
NPI:1376844035
Name:SEASIDE SPEECH SOLUTIONS, PLLC
Entity Type:Organization
Organization Name:SEASIDE SPEECH SOLUTIONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:AINSLEY
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:TAYLOE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC/SLP
Authorized Official - Phone:919-538-9705
Mailing Address - Street 1:3124 CAMDEN CIR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2610
Mailing Address - Country:US
Mailing Address - Phone:919-538-9705
Mailing Address - Fax:
Practice Address - Street 1:3124 CAMDEN CIR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2610
Practice Address - Country:US
Practice Address - Phone:919-538-9705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7718235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty