Provider Demographics
NPI:1710025473
Name:FUNCTIONAL SPEECH THERAPY SERVICES
Entity Type:Organization
Organization Name:FUNCTIONAL SPEECH THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:L
Authorized Official - Last Name:STAPLETON
Authorized Official - Suffix:
Authorized Official - Credentials:MA,CCC-SLP
Authorized Official - Phone:704-796-2237
Mailing Address - Street 1:PO BOX 556
Mailing Address - Street 2:
Mailing Address - City:LANDIS
Mailing Address - State:NC
Mailing Address - Zip Code:28088-0556
Mailing Address - Country:US
Mailing Address - Phone:704-796-2237
Mailing Address - Fax:
Practice Address - Street 1:644 STATESVILLE BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2280
Practice Address - Country:US
Practice Address - Phone:704-796-2237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3783235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty