Provider Demographics
NPI:1205063138
Name:COMMUNICATION 360 LLC
Entity type:Organization
Organization Name:COMMUNICATION 360 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:OPAL
Authorized Official - Middle Name:DIONNE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MED CCC-SLP
Authorized Official - Phone:919-771-6830
Mailing Address - Street 1:PO BOX 29
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-0029
Mailing Address - Country:US
Mailing Address - Phone:919-771-6830
Mailing Address - Fax:888-422-2757
Practice Address - Street 1:742 MCKNIGHT DR
Practice Address - Street 2:SUITE 221
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-7764
Practice Address - Country:US
Practice Address - Phone:919-771-6830
Practice Address - Fax:888-422-2757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2011-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4240235Z00000X
CA19026235Z00000X
NC6914235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7200283Medicaid