Provider Demographics
NPI:1740603661
Name:EARLY SPEECH SERVICES.
Entity Type:Organization
Organization Name:EARLY SPEECH SERVICES.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:THEYS
Authorized Official - Suffix:
Authorized Official - Credentials:MS-CCC SLP
Authorized Official - Phone:919-915-1893
Mailing Address - Street 1:68 BENT CREEK COURT
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527
Mailing Address - Country:US
Mailing Address - Phone:919-915-1893
Mailing Address - Fax:866-432-6140
Practice Address - Street 1:68 BENT CREEK COURT
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27527
Practice Address - Country:US
Practice Address - Phone:919-915-1893
Practice Address - Fax:866-432-6140
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASHGROVE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-29
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8539235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7413265Medicaid