SPEECH AND LANGUAGE REHABILITATION SERVICES, INC.

Provider Demographics

• NPI: 1891858692
• Name: SPEECH AND LANGUAGE REHABILITATION SERVICES, INC.
• Entity Type: Organization
• Organization Name: SPEECH AND LANGUAGE REHABILITATION SERVICES, INC.
• Authorized Official - Title/Position: SPEECH PATHOLOGIST,PRESIDENT
• Authorized Official - Prefix: MRS
• Authorized Official - First Name: NELLIE
• Authorized Official - Middle Name: HERRING
• Authorized Official - Last Name: HUDSON
• Authorized Official - Credentials: MS, CCC,SLP
• Authorized Official - Phone: 910-299-0700
• Mailing Address - Street 1: PO BOX 1414
• Mailing Address - City: CLINTON
• Mailing Address - State: NC
• Mailing Address - Zip Code: 28329
• Mailing Address - Country: US
• Mailing Address - Phone: 910-299-0700
• Mailing Address - Fax: 910-299-0800
• Practice Address - Street 1: 600 SUNSET AVE
• Practice Address - City: CLINTON
• Practice Address - State: NC
• Practice Address - Zip Code: 28328-3946
• Practice Address - Country: US
• Practice Address - Phone: 910-299-0700
• Practice Address - Fax: 910-299-0800
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-12-19
• Last Update Date: 2011-10-19

Provider Licenses

State	License ID	Taxonomies
NC	SLP-A 0036	2355S0801X
NC	SLP-A 0064	2355S0801X
NC	SLP-A 0021	2355S0801X
NC	SLP-A 0103	2355S0801X
NC	SLP-A 0058	2355S0801X
NC	SLP-A 0168	2355S0801X
NC	932	235Z00000X
NC	2717	235Z00000X
NC	6808	235Z00000X
NC	6207	235Z00000X
NC	7693	235Z00000X
NC	7671	235Z00000X
NC	7899	235Z00000X
NC	6950	235Z00000X
		251S00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	235Z00000X	Speech, Language and Hearing Service Providers	Speech-Language Pathologist		Group - Multi-Specialty
No	2355S0801X	Speech, Language and Hearing Service Providers	Specialist/Technologist	Speech-Language Assistant	Group - Multi-Specialty
No	251S00000X	Agencies	Community/Behavioral Health		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
NC	7412837	Medicaid
NC	7412848	Medicaid
NC	7412838	Medicaid
NC	7413237	Medicaid
NC	7210690	Medicaid
NC	7412156	Medicaid
NC	8300101	Medicaid
NC	7413581	Medicaid
NC	7444344	Medicaid
NC	0166Q	Other	BCBS
NC	7411318	Medicaid
NC	8300101K	Medicaid