Provider Demographics
NPI:1578314753
Name:BUILDING BLOCKS SPEECH AND LANGUAGE THERAPY, PLLC
Entity Type:Organization
Organization Name:BUILDING BLOCKS SPEECH AND LANGUAGE THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:631-560-9118
Mailing Address - Street 1:10721 SURREY GREEN LN APT 117
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-8965
Mailing Address - Country:US
Mailing Address - Phone:631-560-9118
Mailing Address - Fax:
Practice Address - Street 1:115 UNIONVILLE INDIAN TRAIL RD W STE E2
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-5583
Practice Address - Country:US
Practice Address - Phone:704-218-9320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-27
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist