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General NPI Number Information
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NPI Number | 1629751219
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Entity Type | Organization
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Legal Business Name | BLUE RIDGE SPEECH, LLC.
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Dates
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Enumeration Date | 08/09/2023
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Last Update Date | 08/09/2023
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Provider Practice Location Address
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Address Line | 385 FAIRWAY LN
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City | WILKESBORO
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State | NC
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Zip | 28697-7506
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Country | US
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Telephone | 336-957-1088
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Fax |
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Provider Business Mailing Address
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Address Line | 385 FAIRWAY LN
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City | WILKESBORO
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State | NC
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Zip | 28697-7506
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Country | US
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Telephone | 369-571-0883
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Fax |
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Authorized Official
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Title or Position | SLP/OWNER
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Name | BROOKE H WELBORN
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Credential | MS,CCC/SLP
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Telephone | 336-957-1088
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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 |
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License Number State |
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