=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174334270
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FULL CIRCLE SPEECH THERAPY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2025
-----------------------------------------------------
Last Update Date | 03/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 302 TRAIL FOUR
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27215-5522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-494-6865
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1183 UNIVERSITY DR STE 105 PMB 3025
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/SPEECH LANGUAGE PATHOLOGIST
-----------------------------------------------------
Name | LAUREN MILES
-----------------------------------------------------
Credential | MS CCC-SLP
-----------------------------------------------------
Telephone | 336-494-6865
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------