Provider Demographics
NPI:1629107982
Name:POOLE, FELICIA (MED)
Entity Type:Individual
Prefix:MRS
First Name:FELICIA
Middle Name:
Last Name:POOLE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5084
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27435-0084
Mailing Address - Country:US
Mailing Address - Phone:336-254-5389
Mailing Address - Fax:336-373-0143
Practice Address - Street 1:5401 HIGHSTREAM CT
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-5827
Practice Address - Country:US
Practice Address - Phone:336-254-5398
Practice Address - Fax:336-834-3109
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4874235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412004Medicaid