=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659833275
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CRECER SPEECH AND LANGUAGE THERAPY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2019
-----------------------------------------------------
Last Update Date | 01/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4030 SOUTHVIEW DR
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27407-9739
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-675-4598
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4030 SOUTHVIEW DR
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27407-9739
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-675-4598
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH AND LANGUAGE PATHOLOGIST
-----------------------------------------------------
Name | BLANCA LILIAN SEGOVIA
-----------------------------------------------------
Credential | M.ED., CCC-SLP
-----------------------------------------------------
Telephone | 336-675-4598
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------