Healthcare Provider Details

I. General information

NPI: 1578646865
Provider Name (Legal Business Name): CHARLOTTE SPEECH AND HEARING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 10/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 KENILWORTH AVENUE SUITE 100
CHARLOTTE NC
28204-2933
US

IV. Provider business mailing address

741 KENILWORTH AVENUE SUITE 100
CHARLOTTE NC
28204-2933
US

V. Phone/Fax

Practice location:
  • Phone: 704-523-8027
  • Fax: 704-523-8031
Mailing address:
  • Phone: 704-523-8027
  • Fax: 704-523-8031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHANNON LYNN TUCKER
Title or Position: EXECUTIVE DIRECTOR
Credential: CCC-SLP
Phone: 704-523-8027