Healthcare Provider Details

I. General information

NPI: 1407977747
Provider Name (Legal Business Name): SPEECH&LANGUAGE FOUNDATION PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 10/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5330 RAEFORD RD
FAYETTEVILLE NC
28304-3074
US

IV. Provider business mailing address

PO BOX 26034
FAYETTEVILLE NC
28314-5017
US

V. Phone/Fax

Practice location:
  • Phone: 910-488-4100
  • Fax: 910-483-8721
Mailing address:
  • Phone: 910-488-4100
  • Fax: 910-483-8721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. SONYA EVANS OATES
Title or Position: OWNER
Credential: MSCCC-SLP
Phone: 910-488-7309