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General NPI Number Information
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NPI Number | 1518414234
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Entity Type | Organization
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Legal Business Name | DOGWOOD DEVELOPMENTAL THERAPY
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Dates
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Enumeration Date | 09/10/2016
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Last Update Date | 01/27/2017
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Provider Practice Location Address
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Address Line | 16525 US HIGHWAY 17 N #D
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City | HAMPSTEAD
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State | NC
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Zip | 28443-7440
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Country | US
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Telephone | 910-824-4394
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Fax |
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Provider Business Mailing Address
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Address Line | 441 MCPHEE DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28305-5129
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Country | US
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Telephone | 910-824-4394
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Fax |
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Authorized Official
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Title or Position | CCC-SLP
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Name | STACY E WILSON
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Credential | M.S.
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Telephone | 910-824-4394
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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 | 8028
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License Number State | NC
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