Provider Demographics
NPI:1821422585
Name:CAROLINA SPEECH & LANGUAGE, PLLC
Entity Type:Organization
Organization Name:CAROLINA SPEECH & LANGUAGE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BODDICKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-244-8640
Mailing Address - Street 1:105 SKYWATER LN
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-9489
Mailing Address - Country:US
Mailing Address - Phone:919-244-8640
Mailing Address - Fax:
Practice Address - Street 1:105 SKYWATER LN
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-9489
Practice Address - Country:US
Practice Address - Phone:919-244-8640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty