MEDICARE: BRAINSTORM COGNITIVE WELLNESS AND SPEECH THERAPY

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

General Provider Information

NPI Number	:	1194332825
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAINSTORM COGNITIVE WELLNESS AND SPEECH THERAPY

Provider Business Mailing Address
First Line	:	9212 COLIN CROSSING CT
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-4860
Country	:	US
Telephone Number	:	704-576-4815
Fax Number	:

Provider Business Practice Location Address
First Line	:	8025 CORPORATE CENTER DR STE 200
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-4544
Country	:	US
Telephone Number	:	704-576-4815
Fax Number	:

Authorized Official
Title or Position	:	SPEECH PATHOLOGIST
Name	:	MS. LORI STEPHENSON KURY
Credential	:	M.S.CCC-SLP
Telephone Number	:	704-576-4815

Provider Enumeration Date	:	09/27/2020
Last Update Date	:	09/27/2020

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Directions to “BRAINSTORM COGNITIVE WELLNESS AND SPEECH THERAPY ” Practice Location

Language	Start Address	Practice Location

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