Provider Demographics
NPI:1801492616
Name:AVENUE THERAPY SERVICES
Entity type:Organization
Organization Name:AVENUE THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:VENISE
Authorized Official - Last Name:EDGERTON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:336-223-6096
Mailing Address - Street 1:2159 MACKENNA DR
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253-5428
Mailing Address - Country:US
Mailing Address - Phone:336-223-6096
Mailing Address - Fax:336-586-5356
Practice Address - Street 1:2159 MACKENNA DR
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:NC
Practice Address - Zip Code:27253-5428
Practice Address - Country:US
Practice Address - Phone:919-283-9067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-07
Last Update Date:2023-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty