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NPI 1093284572

NPI 1093284572 : TRIANGLE SPEECH AND LANGUAGE SERVICES : HOLLY SPRINGS, NC

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General NPI Number Information
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    NPI Number           |    1093284572
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    Entity Type          |    Organization 
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    Legal Business Name  |    TRIANGLE SPEECH AND LANGUAGE SERVICES 
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Dates
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    Enumeration Date     |    11/14/2018
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    Last Update Date     |    11/14/2018
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Provider Practice Location Address
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    Address Line         |    124 SWEET VIOLET DR 
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    City                 |    HOLLY SPRINGS
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    State                |    NC
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    Zip                  |    27540-9804
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    Country              |    US
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    Telephone            |    919-302-7291
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    124 SWEET VIOLET DR 
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    City                 |    HOLLY SPRINGS
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    State                |    NC
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    Zip                  |    27540-9804
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    Country              |    US
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    Telephone            |    919-302-7291
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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                 |     ALYSON GUSTIN PEREIRA 
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    Credential           |    MA, CCC-SLP
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    Telephone            |    919-302-7291
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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       |    
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    License Number State |    
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