Provider Demographics
NPI:1982026647
Name:SPEECH PALS THERAPY, PLLC
Entity Type:Organization
Organization Name:SPEECH PALS THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARAFA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-399-8299
Mailing Address - Street 1:314 LODER AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-4340
Mailing Address - Country:US
Mailing Address - Phone:910-399-8299
Mailing Address - Fax:910-793-3148
Practice Address - Street 1:314 LODER AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28409-4340
Practice Address - Country:US
Practice Address - Phone:910-399-8299
Practice Address - Fax:910-793-3148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-15
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6777235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412948Medicaid