Provider Demographics
NPI:1679042899
Name:FOUNDATIONS SPEECH PATHOLOGY
Entity Type:Organization
Organization Name:FOUNDATIONS SPEECH PATHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRASS
Authorized Official - Suffix:
Authorized Official - Credentials:M ED, CCC-SLP
Authorized Official - Phone:919-455-1951
Mailing Address - Street 1:3832 DOESKIN DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27539-8643
Mailing Address - Country:US
Mailing Address - Phone:919-455-1951
Mailing Address - Fax:919-887-2781
Practice Address - Street 1:3832 DOESKIN DR
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27539-8643
Practice Address - Country:US
Practice Address - Phone:919-455-1951
Practice Address - Fax:919-887-2781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-16
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty