1891858692 NPI number — SPEECH AND LANGUAGE REHABILITATION SERVICES, INC.

Table of content: (NPI 1891858692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891858692 NPI number — SPEECH AND LANGUAGE REHABILITATION SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPEECH AND LANGUAGE 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:
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:
1891858692
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1414
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-299-0700
Provider Business Mailing Address Fax Number:
910-299-0800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 SUNSET AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28328-3946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-299-0700
Provider Business Practice Location Address Fax Number:
910-299-0800
Provider Enumeration Date:
12/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HUDSON
Authorized Official First Name:
NELLIE
Authorized Official Middle Name:
HERRING
Authorized Official Title or Position:
SPEECH PATHOLOGIST,PRESIDENT
Authorized Official Telephone Number:
910-299-0700

Provider Taxonomy Codes

  • Taxonomy code: 2355S0801X , with the licence number:  SLP-A 0036 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2355S0801X , with the licence number: SLP-A 0064 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2355S0801X , with the licence number: SLP-A 0021 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2355S0801X , with the licence number: SLP-A 0103 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2355S0801X , with the licence number: SLP-A 0058 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2355S0801X , with the licence number: SLP-A 0168 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 932 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 235Z00000X , with the licence number: 2717 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 6808 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 6207 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 7693 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 7671 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 7899 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 6950 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 7412837 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7412848 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7412838 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7413237 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7210690 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7412156 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300101 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7413581 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7444344 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0166Q . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7411318 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300101K , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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