MEDICARE: MRS. TAMI H. EKLUND M.A. CCC-SLP

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	2125	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255328167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAMI H. EKLUND M.A. CCC-SLP

Provider Business Mailing Address
First Line	:	200 WADE HAMPTON DR
Second Line	:
City	:	MATTHEWS
State	:	NC
Zip	:	28104-6376
Country	:	US
Telephone Number	:	704-995-1465
Fax Number	:	704-283-6181

Provider Business Practice Location Address
First Line	:	200 WADE HAMPTON DR
Second Line	:
City	:	MATTHEWS
State	:	NC
Zip	:	28104-6376
Country	:	US
Telephone Number	:	704-995-1465
Fax Number	:	704-283-6181

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	10/26/2007

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Directions to “ MRS. TAMI H. EKLUND M.A. CCC-SLP” Practice Location

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