=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427690460
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EXCEL AND ACHIEVE SPEECH THERAPY SERVICES, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2019
-----------------------------------------------------
Last Update Date | 10/10/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5401 HIGHSTREAM CT
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27407-5827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-254-5398
-----------------------------------------------------
Fax | 336-834-3109
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 5084
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27435-0084
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-254-5398
-----------------------------------------------------
Fax | 336-834-3109
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | FELICIA POOLE
-----------------------------------------------------
Credential | MED. CCC/SLP
-----------------------------------------------------
Telephone | 336-254-5398
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------