1306303490 NPI number — CAROLINA SPEECH ACADEMY, PLLC

Table of content: (NPI 1306303490)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306303490 NPI number — CAROLINA SPEECH ACADEMY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINA SPEECH ACADEMY, PLLC
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:
CARGILL COMMUNICATIONS, LLC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306303490
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
112 S CENTURION LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT HOLLY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28120-8716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-264-3321
Provider Business Mailing Address Fax Number:
704-601-5308

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 S CENTURION LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT HOLLY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28120-8716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-264-3321
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/25/2019

Additional Information

Authorized Official

Authorized Official Last Name:
CARGILL
Authorized Official First Name:
MAUREEN
Authorized Official Middle Name:
JANELLE
Authorized Official Title or Position:
SPEECH LANGUAGE PATHOLOGIST/OWNER
Authorized Official Telephone Number:
856-264-3321

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1306303490 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1326462938 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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