Healthcare Provider Details

I. General information

NPI: 1790173235
Provider Name (Legal Business Name): SPEECH 4 KIDZ AND MORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2015
Last Update Date: 01/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 OFFICE PARK DR
JACKSONVILLE NC
28546-3218
US

IV. Provider business mailing address

5919 OLEANDER DR SUITE 119
WILMINGTON NC
28403-4780
US

V. Phone/Fax

Practice location:
  • Phone: 910-395-2995
  • Fax: 910-313-0951
Mailing address:
  • Phone: 910-470-7937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: AMY HOWARD
Title or Position: OWNER
Credential: M.S., CCC-SLP
Phone: 910-395-2995