Provider Demographics
NPI:1821148180
Name:SPEECH-LANGUAGE PATHOLOGY SERVICES, INC.
Entity Type:Organization
Organization Name:SPEECH-LANGUAGE PATHOLOGY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MSP,CCC-SLP
Authorized Official - Phone:910-914-6100
Mailing Address - Street 1:109 EAST WYCHE STREET
Mailing Address - Street 2:PO BOX 762
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-0762
Mailing Address - Country:US
Mailing Address - Phone:910-914-6100
Mailing Address - Fax:910-914-6095
Practice Address - Street 1:109 E WYCHE ST
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-3429
Practice Address - Country:US
Practice Address - Phone:910-914-6100
Practice Address - Fax:910-914-6095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3904235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7200561Medicaid
NC7470724Medicaid