1588937809 NPI number — THERAPLAY SPEECH & LANGUAGE SERVICES, PLLC

Table of content: JULIA TACEY (NPI 1497498034)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588937809 NPI number — THERAPLAY SPEECH & LANGUAGE SERVICES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THERAPLAY SPEECH & LANGUAGE SERVICES, 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:
1588937809
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
122 BROOKWOOD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28403-1110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-612-2814
Provider Business Mailing Address Fax Number:
910-341-7908

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
122 BROOKWOOD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28403-1110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-612-2814
Provider Business Practice Location Address Fax Number:
910-341-7908
Provider Enumeration Date:
02/16/2012

Additional Information

Authorized Official

Authorized Official Last Name:
SNOW
Authorized Official First Name:
CELIA
Authorized Official Middle Name:
LIPPITT
Authorized Official Title or Position:
SPEECH PATHOLOGIST/OWNER
Authorized Official Telephone Number:
910-612-2814

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: 7411502 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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