Provider Demographics
NPI:1821240656
Name:BASHAM, PEPPER D (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PEPPER
Middle Name:D
Last Name:BASHAM
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 CAROLINA HOLLY WAY
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-9282
Mailing Address - Country:US
Mailing Address - Phone:828-490-6955
Mailing Address - Fax:
Practice Address - Street 1:600 CAROLINA HOLLY WAY
Practice Address - Street 2:
Practice Address - City:FLETCHER
Practice Address - State:NC
Practice Address - Zip Code:28732-9282
Practice Address - Country:US
Practice Address - Phone:828-490-6955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-10
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
NC10850235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty