Provider Demographics
NPI:1558409706
Name:PEDIATRIC SPEECH & LANGUAGE SERVICES INC
Entity Type:Organization
Organization Name:PEDIATRIC SPEECH & LANGUAGE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:PARRISH
Authorized Official - Suffix:
Authorized Official - Credentials:MED, CCC/SLP LSLS C
Authorized Official - Phone:336-294-8091
Mailing Address - Street 1:PO BOX 9804
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27429-0804
Mailing Address - Country:US
Mailing Address - Phone:336-541-8167
Mailing Address - Fax:336-663-0266
Practice Address - Street 1:3201 W MARKET ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1455
Practice Address - Country:US
Practice Address - Phone:336-541-8167
Practice Address - Fax:336-663-0266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC222Q00000X, 235Z00000X, 252Y00000X
NC1174235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8303400Medicaid
NC740236BMedicaid