Provider Demographics
NPI:1023174109
Name:CAROLINA SPEECH SERVICES, INC.
Entity type:Organization
Organization Name:CAROLINA SPEECH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAQUINTA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALDUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-488-5104
Mailing Address - Street 1:PO BOX 49663
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-0082
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2101 SARDIS RD N
Practice Address - Street 2:STE 112
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-7711
Practice Address - Country:US
Practice Address - Phone:704-488-5104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-31
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211628Medicaid