Provider Demographics
NPI:1619108982
Name:PHILLIPS, IRIS BRASWELL (AUD)
Entity Type:Individual
Prefix:DR
First Name:IRIS
Middle Name:BRASWELL
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:IRIS
Other - Middle Name:BRASWELL
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:7300 SOUTH RAEFORD ROAD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304
Mailing Address - Country:US
Mailing Address - Phone:910-822-7983
Mailing Address - Fax:910-822-7088
Practice Address - Street 1:7300 SOUTH RAEFORD ROAD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304
Practice Address - Country:US
Practice Address - Phone:910-822-7983
Practice Address - Fax:910-822-7088
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-04
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2316231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist