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General NPI Number Information
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NPI Number | 1407977747
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Entity Type | Organization
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Legal Business Name | SPEECH&LANGUAGE FOUNDATION PLLC
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 10/14/2014
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Provider Practice Location Address
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Address Line | 5330 RAEFORD RD
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3074
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Country | US
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Telephone | 910-488-4100
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Fax | 910-483-8721
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Provider Business Mailing Address
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Address Line | PO BOX 26034
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-5017
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Country | US
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Telephone | 910-488-4100
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Fax | 910-483-8721
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SONYA EVANS OATES
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Credential | MSCCC-SLP
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Telephone | 910-488-7309
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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Taxonomy #3
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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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