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General NPI Number Information
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NPI Number | 1144663535
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Entity Type | Organization
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Legal Business Name | LAND PEDIATRIC SPEECH THERAPY
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Dates
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Enumeration Date | 04/16/2013
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Last Update Date | 04/16/2013
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Provider Practice Location Address
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Address Line | 4108 CASCADE DR
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City | GREENSBORO
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State | NC
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Zip | 27410-3910
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Country | US
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Telephone | 336-202-7604
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Fax | 336-852-9342
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Provider Business Mailing Address
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Address Line | 4108 CASCADE DR
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City | GREENSBORO
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State | NC
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Zip | 27410-3910
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Country | US
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Telephone | 336-202-7604
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Fax | 336-852-9342
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Authorized Official
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Title or Position | OWNER
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Name | TANIA L.B. LAND
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Credential | CCC-SLP
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Telephone | 336-202-7604
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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 | 4424
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License Number State | NC
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