Provider Demographics
NPI:1477024958
Name:SPEECH KIDZ, LLC
Entity Type:Organization
Organization Name:SPEECH KIDZ, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:PUMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-899-4183
Mailing Address - Street 1:1630 BELLEVUE RD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2165
Mailing Address - Country:US
Mailing Address - Phone:704-899-4183
Mailing Address - Fax:
Practice Address - Street 1:1630 BELLEVUE RD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144
Practice Address - Country:US
Practice Address - Phone:704-899-4183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-10
Last Update Date:2019-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty