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General NPI Number Information
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NPI Number | 1073062998
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Entity Type | Organization
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Legal Business Name | BANNER SPEECH THERAPY, PLLC
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Dates
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Enumeration Date | 10/04/2016
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Last Update Date | 10/04/2016
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Provider Practice Location Address
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Address Line | 1010 RANDOLPH ST
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City | THOMASVILLE
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State | NC
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Zip | 27360-5877
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Country | US
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Telephone | 336-337-3478
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Fax |
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Provider Business Mailing Address
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Address Line | 6155 RED CEDAR DR APT. 2C
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City | HIGH POINT
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State | NC
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Zip | 27265-7171
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Country | US
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Telephone | 336-337-3478
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Fax |
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | MRS. REBECCA M SETZER
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Credential | MA, CCC-SLP
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Telephone | 336-337-3478
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 6171
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License Number State | NC
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