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General NPI Number Information
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NPI Number | 1740608215
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Entity Type | Organization
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Legal Business Name | CROSSROADS SPEECH THERAPY, PLLC
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Dates
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Enumeration Date | 04/02/2014
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Last Update Date | 04/02/2014
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Provider Practice Location Address
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Address Line | 193 DONSDALE DR
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City | STATESVILLE
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State | NC
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Zip | 28625-1658
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Country | US
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Telephone | 704-876-4043
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Fax |
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Provider Business Mailing Address
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Address Line | 193 DONSDALE DR
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City | STATESVILLE
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State | NC
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Zip | 28625-1658
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Country | US
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Telephone | 704-876-4043
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | STEVEN R ROBERTS
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Credential | M.S., CCC-SLP
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Telephone | 704-876-4043
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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 | 9756
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License Number State | NC
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