Provider Demographics
NPI:1508274432
Name:BLUE RIDGE SPEECH THERAPY
Entity Type:Organization
Organization Name:BLUE RIDGE SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:PHARR
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:828-263-8871
Mailing Address - Street 1:286 DEERFIELD FOREST PKWY
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-8453
Mailing Address - Country:US
Mailing Address - Phone:828-263-8871
Mailing Address - Fax:828-263-8898
Practice Address - Street 1:286 DEERFIELD FOREST PKWY
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-8453
Practice Address - Country:US
Practice Address - Phone:828-263-8871
Practice Address - Fax:828-263-8898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3513235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7467511Medicaid
NC7401098Medicaid