Provider Demographics
NPI:1407977747
Name:SPEECH&LANGUAGE FOUNDATION PLLC
Entity Type:Organization
Organization Name:SPEECH&LANGUAGE FOUNDATION PLLC
Other - Org Name:NEED SPEECH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:EVANS
Authorized Official - Last Name:OATES
Authorized Official - Suffix:
Authorized Official - Credentials:MSCCC-SLP
Authorized Official - Phone:910-488-7309
Mailing Address - Street 1:PO BOX 26034
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-5017
Mailing Address - Country:US
Mailing Address - Phone:910-488-4100
Mailing Address - Fax:910-483-8721
Practice Address - Street 1:5330 RAEFORD RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3074
Practice Address - Country:US
Practice Address - Phone:910-488-4100
Practice Address - Fax:910-483-8721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300112Medicaid