Provider Demographics
NPI:1649583212
Name:ADVANCED SPEECH AND LANGUAGE THERAPY PLLC
Entity Type:Organization
Organization Name:ADVANCED SPEECH AND LANGUAGE THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:SAWYER
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:910-213-6425
Mailing Address - Street 1:6914 S STAFF RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-2517
Mailing Address - Country:US
Mailing Address - Phone:910-213-6425
Mailing Address - Fax:910-484-6760
Practice Address - Street 1:6914 S STAFF RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-2517
Practice Address - Country:US
Practice Address - Phone:910-213-6425
Practice Address - Fax:910-484-6760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7414235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty