Provider Demographics
NPI:1578080040
Name:AGAPE SPEECH AND LANGUAGE SERVICES
Entity Type:Organization
Organization Name:AGAPE SPEECH AND LANGUAGE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:PICKARD
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC SLP
Authorized Official - Phone:336-686-5180
Mailing Address - Street 1:3405 QUARTERHORSE CT
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27358-9096
Mailing Address - Country:US
Mailing Address - Phone:1336-686-5180
Mailing Address - Fax:
Practice Address - Street 1:3405 QUARTERHORSE CT
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:NC
Practice Address - Zip Code:27358-9096
Practice Address - Country:US
Practice Address - Phone:1336-686-5180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-25
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4883261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech