Provider Demographics
NPI:1528017027
Name:CENTER FOR SPEECH LANGUAGE AND LEARNING
Entity Type:Organization
Organization Name:CENTER FOR SPEECH LANGUAGE AND LEARNING
Other - Org Name:SUSAN A. KHAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:919-932-7160
Mailing Address - Street 1:PO BOX 2712
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27515-2712
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1703 LEGION RD
Practice Address - Street 2:SUITE 204
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-2359
Practice Address - Country:US
Practice Address - Phone:919-932-7160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC016GROtherBCBSNC
NC7211685Medicaid