Provider Demographics
NPI:1639504103
Name:EXPRESSIVE BEGINNINGS SPEECH-LANGUAGE PATHOLOGY SERVICES, PLLC
Entity Type:Organization
Organization Name:EXPRESSIVE BEGINNINGS SPEECH-LANGUAGE PATHOLOGY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:H
Authorized Official - Last Name:NELON
Authorized Official - Suffix:
Authorized Official - Credentials:MED, CCC-SLP
Authorized Official - Phone:910-308-7895
Mailing Address - Street 1:3325 KING JAMES LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-7549
Mailing Address - Country:US
Mailing Address - Phone:910-308-7895
Mailing Address - Fax:910-292-6612
Practice Address - Street 1:3325 KING JAMES LN
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-7549
Practice Address - Country:US
Practice Address - Phone:910-308-7895
Practice Address - Fax:910-292-6612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5251235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty