Healthcare Provider Details

I. General information

NPI: 1922604867
Provider Name (Legal Business Name): SPEAKEZ THERACARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2020
Last Update Date: 12/30/2020
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12757 PERSIMMON TREE DR
CHARLOTTE NC
28273-8023
US

IV. Provider business mailing address

12757 PERSIMMON TREE DR
CHARLOTTE NC
28273-8023
US

V. Phone/Fax

Practice location:
  • Phone: 347-757-7832
  • Fax:
Mailing address:
  • Phone: 347-757-7832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. SENSEMILLAH PETERS-LEWIS
Title or Position: OWNER/SPEECH-LANGUAGE PATHOLOGIST
Credential:
Phone: 347-757-7832