Provider Demographics
NPI:1891190971
Name:THE SPEECH TREE, LLC
Entity Type:Organization
Organization Name:THE SPEECH TREE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:WILENA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MED,CCC-SLP
Authorized Official - Phone:910-740-6948
Mailing Address - Street 1:3257 DEEP BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28360-4903
Mailing Address - Country:US
Mailing Address - Phone:910-740-6948
Mailing Address - Fax:910-802-4688
Practice Address - Street 1:3257 DEEP BRANCH RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28360-4903
Practice Address - Country:US
Practice Address - Phone:910-740-6948
Practice Address - Fax:910-802-4688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8616235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty