=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669583720
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALPHA & OMEGA SPEECH THERAPY CONSULTANTS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 07/10/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 509 BUTLER RD
-----------------------------------------------------
City | FOREST CITY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28043-6108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-248-1214
-----------------------------------------------------
Fax | 828-247-8828
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 509 BUTLER RD
-----------------------------------------------------
City | FOREST CITY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28043-6108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-248-1214
-----------------------------------------------------
Fax | 828-247-8828
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER/MANAGER
-----------------------------------------------------
Name | MS. LINDA CONLEY-COX
-----------------------------------------------------
Credential | M.S. CCC-SLP
-----------------------------------------------------
Telephone | 828-248-1214
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 5989
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------