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General NPI Number Information
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NPI Number | 1942969167
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Entity Type | Organization
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Legal Business Name | PEDIATRIC COMMUNICATION CONNECTION, PLLC
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Dates
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Enumeration Date | 12/15/2021
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Last Update Date | 12/15/2021
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Provider Practice Location Address
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Address Line | 4528 SHUFORD LAKE RD
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City | LAWNDALE
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State | NC
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Zip | 28090-9030
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Country | US
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Telephone | 704-473-2843
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Fax | 704-448-2014
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Provider Business Mailing Address
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Address Line | 4528 SHUFORD LAKE RD
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City | LAWNDALE
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State | NC
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Zip | 28090-9030
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Country | US
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Telephone | 704-473-2843
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Fax | 704-448-2014
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Authorized Official
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Title or Position | OWNER/LEAD SLP
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Name | JENNIFER G WHITE
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Credential | MS, CCC-SLP
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Telephone | 704-473-2843
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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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