MEDICARE: BIRDSONG THERAPY SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	4739	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033302666
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIRDSONG THERAPY SERVICES

Provider Business Mailing Address
First Line	:	683 OLD US HIGHWAY 421
Second Line	:
City	:	SUGAR GROVE
State	:	NC
Zip	:	28679-9549
Country	:	US
Telephone Number	:	828-297-6363
Fax Number	:

Provider Business Practice Location Address
First Line	:	683 OLD US HIGHWAY 421
Second Line	:
City	:	SUGAR GROVE
State	:	NC
Zip	:	28679-9549
Country	:	US
Telephone Number	:	828-297-6363
Fax Number	:

Authorized Official
Title or Position	:	CCC-SLP
Name	:	PATRICIA BIRDSONG
Credential	:
Telephone Number	:	828-297-6363

Provider Enumeration Date	:	08/27/2007
Last Update Date	:	08/27/2007

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Directions to “BIRDSONG THERAPY SERVICES ” Practice Location

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