Healthcare Provider Details

I. General information

NPI: 1417154725
Provider Name (Legal Business Name): ECU SPEECH LANGUAGE & HEARING CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 HEALTH SCIENCES BLDG
GREENVILLE NC
27858
US

IV. Provider business mailing address

4227 OLDE BASS FARM RD
ROCKY MOUNT NC
27804-9172
US

V. Phone/Fax

Practice location:
  • Phone: 252-321-3303
  • Fax:
Mailing address:
  • Phone: 252-985-3417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4942
License Number StateNC

VIII. Authorized Official

Name: DR. BETTY SMITH
Title or Position: CLINIC SUPERVISOR
Credential: MS-CCC-SLP
Phone: 252-321-4403