Provider Demographics
NPI:1548207921
Name:SALEM SPEECH & LANGUAGE SERVICES, INC.
Entity Type:Organization
Organization Name:SALEM SPEECH & LANGUAGE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:CRALIDIS
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC/SP
Authorized Official - Phone:336-830-0287
Mailing Address - Street 1:811 W 5TH ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-2551
Mailing Address - Country:US
Mailing Address - Phone:336-830-0287
Mailing Address - Fax:
Practice Address - Street 1:811 W 5TH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-2551
Practice Address - Country:US
Practice Address - Phone:336-830-0287
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3742235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC=========OtherFEDERAL TAX ID