Provider Demographics
NPI:1679634083
Name:SPEECH THERAPY PLUS, INC.
Entity Type:Organization
Organization Name:SPEECH THERAPY PLUS, INC.
Other - Org Name:SPEECH THERAPY PLUS, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAYSE
Authorized Official - Middle Name:FIELDS
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-717-8005
Mailing Address - Street 1:105 FLORIDA AVE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:CAROLINA BCH
Mailing Address - State:NC
Mailing Address - Zip Code:28428-5802
Mailing Address - Country:US
Mailing Address - Phone:252-633-6770
Mailing Address - Fax:877-335-6220
Practice Address - Street 1:105 FLORIDA AVE
Practice Address - Street 2:UNIT 2
Practice Address - City:CAROLINA BCH
Practice Address - State:NC
Practice Address - Zip Code:28428-5802
Practice Address - Country:US
Practice Address - Phone:252-633-6770
Practice Address - Fax:877-335-6220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4866225X00000X
NC5465235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211527Medicaid