1063770352 NPI number — BJM SPEECH LANGUAGE THERAPY & REHABILITATION SERVICES, INC.

Table of content: (NPI 1063770352)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063770352 NPI number — BJM SPEECH LANGUAGE THERAPY & REHABILITATION SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BJM SPEECH LANGUAGE THERAPY & REHABILITATION SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1063770352
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 AVERSBORO RD STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARNER
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27529-3633
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-332-1022
Provider Business Mailing Address Fax Number:
888-972-9297

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 AVERSBORO RD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARNER
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27529-3633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-332-1022
Provider Business Practice Location Address Fax Number:
888-972-9297
Provider Enumeration Date:
04/25/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MADUJIBEYA
Authorized Official First Name:
BELINDA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
SPEECH LANGUAGE PATHOLOGIST
Authorized Official Telephone Number:
919-662-0456

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  2143 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QH0700X , with the licence number: 2143 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)