Provider Demographics
NPI:1477699700
Name:ATLANTIC SPEECH THERAPY, P.C.
Entity Type:Organization
Organization Name:ATLANTIC SPEECH THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:BROWNING
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:910-343-5885
Mailing Address - Street 1:1430 COMMONWEALTH DR STE 300
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-0351
Mailing Address - Country:US
Mailing Address - Phone:910-343-5885
Mailing Address - Fax:910-343-5886
Practice Address - Street 1:1430 COMMONWEALTH DR STE 300
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-0351
Practice Address - Country:US
Practice Address - Phone:910-343-5885
Practice Address - Fax:910-343-5886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6449235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7212064Medicaid