Provider Demographics
NPI:1578646865
Name:CHARLOTTE SPEECH AND HEARING CENTER, INC.
Entity Type:Organization
Organization Name:CHARLOTTE SPEECH AND HEARING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:704-523-8027
Mailing Address - Street 1:741 KENILWORTH AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2933
Mailing Address - Country:US
Mailing Address - Phone:704-523-8027
Mailing Address - Fax:704-523-8031
Practice Address - Street 1:741 KENILWORTH AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2933
Practice Address - Country:US
Practice Address - Phone:704-523-8027
Practice Address - Fax:704-523-8031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7001530Medicaid
NC7401042Medicaid