Provider Demographics
NPI:1477037679
Name:PHOENIX RISING SPEECH-LANGUAGE THERAPY SERVICES
Entity Type:Organization
Organization Name:PHOENIX RISING SPEECH-LANGUAGE THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURR
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:336-337-2905
Mailing Address - Street 1:313 GOLDEN ROD LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27295-6889
Mailing Address - Country:US
Mailing Address - Phone:336-337-2905
Mailing Address - Fax:
Practice Address - Street 1:313 GOLDEN ROD LN
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27295-6889
Practice Address - Country:US
Practice Address - Phone:336-337-2905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty