Healthcare Provider Details

I. General information

NPI: 1558409706
Provider Name (Legal Business Name): PEDIATRIC SPEECH & LANGUAGE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 04/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 W MARKET ST
GREENSBORO NC
27403-1455
US

IV. Provider business mailing address

PO BOX 9804
GREENSBORO NC
27429-0804
US

V. Phone/Fax

Practice location:
  • Phone: 336-541-8167
  • Fax: 336-663-0266
Mailing address:
  • Phone: 336-541-8167
  • Fax: 336-663-0266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1174
License Number StateNC

VIII. Authorized Official

Name: MS. KAREN JACKSON PARRISH
Title or Position: OWNER/THERAPIST
Credential: M.ED, CCC/SLP LSLS C
Phone: 336-294-8091