Provider Demographics
NPI:1467871004
Name:PIEDMONT SPEECH, LANGUAGE, AND LEARNING
Entity Type:Organization
Organization Name:PIEDMONT SPEECH, LANGUAGE, AND LEARNING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBEKKAH
Authorized Official - Middle Name:KELLEY
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-589-0311
Mailing Address - Street 1:3705 SAINT CHARLES CT
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-7538
Mailing Address - Country:US
Mailing Address - Phone:704-589-0311
Mailing Address - Fax:
Practice Address - Street 1:3705 SAINT CHARLES CT
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056-7538
Practice Address - Country:US
Practice Address - Phone:704-589-0311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6961235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty