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General NPI Number Information
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NPI Number | 1548789787
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Entity Type | Organization
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Legal Business Name | PRISMATIC SPEECH SERVICES, PLLC
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Dates
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Enumeration Date | 09/19/2017
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Last Update Date | 09/19/2017
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Provider Practice Location Address
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Address Line | 3407 W WENDOVER AVE STE I
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City | GREENSBORO
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State | NC
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Zip | 27407-1584
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Country | US
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Telephone | 336-609-6258
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Fax |
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Provider Business Mailing Address
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Address Line | 2515 WRIGHT AVE
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City | GREENSBORO
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State | NC
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Zip | 27403-1467
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Country | US
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Telephone | 919-619-9412
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Fax |
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Authorized Official
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Title or Position | ORGANIZER
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Name | KEVIN DORMAN
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Credential | MS, CCC-SLP
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Telephone | 336-609-6258
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | 11841
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License Number State | NC
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