Provider Demographics
NPI:1396002341
Name:SPEECH BRIDGE, PLLC
Entity Type:Organization
Organization Name:SPEECH BRIDGE, PLLC
Other - Org Name:SPEECH BRIDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:DEES
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:252-638-3147
Mailing Address - Street 1:153 DEEP RUN DR
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-5206
Mailing Address - Country:US
Mailing Address - Phone:252-638-3147
Mailing Address - Fax:252-636-3170
Practice Address - Street 1:153 DEEP RUN DR
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-5206
Practice Address - Country:US
Practice Address - Phone:252-638-3147
Practice Address - Fax:252-636-3170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6678235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty