1487255311 NPI number — HEALTHY SPEECH SOLUTIONS, PLLC

Table of content: (NPI 1487255311)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487255311 NPI number — HEALTHY SPEECH SOLUTIONS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHY SPEECH SOLUTIONS, 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:
Provider Other Organization Name Type Code:
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:
1487255311
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 524
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARRISBURG
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28075-0524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-583-4886
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 S 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMITHFIELD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27577-4539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-583-4886
Provider Business Practice Location Address Fax Number:
949-561-4742
Provider Enumeration Date:
11/06/2020

Additional Information

Authorized Official

Authorized Official Last Name:
PATTON
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
MELROSE
Authorized Official Title or Position:
SPEECH-LANGUAGE PATHOLOGIST/ OWNER
Authorized Official Telephone Number:
917-583-4886

Provider Taxonomy Codes

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

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

  • Identifier: 110414200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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