Provider Demographics
NPI:1336177997
Name:MTS SPEECH & LANGUAGE SERVICES, INC
Entity Type:Organization
Organization Name:MTS SPEECH & LANGUAGE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MINE
Authorized Official - Middle Name:NESHAWN
Authorized Official - Last Name:THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:M ED, CCC-SLP
Authorized Official - Phone:919-598-9568
Mailing Address - Street 1:PO BOX 52413
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27717
Mailing Address - Country:US
Mailing Address - Phone:919-598-9568
Mailing Address - Fax:919-598-9568
Practice Address - Street 1:3609 TURQUOISE DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703
Practice Address - Country:US
Practice Address - Phone:919-598-9568
Practice Address - Fax:919-598-9568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5173235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC133WCOtherBCBSNC
NC7211011Medicaid
NC7411640Medicaid