MEDICARE: VIRGINIA CARTER INGRAM MS 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	6846	TN
2	235Z00000X	Speech-Language Pathologist	30001489	NC

General Provider Information

NPI Number	:	1346896941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGINIA CARTER INGRAM MS CCC-SLP

Provider Business Mailing Address
First Line	:	10221 MISTY MOSS CT
Second Line	:
City	:	MINT HILL
State	:	NC
Zip	:	28227-8121
Country	:	US
Telephone Number	:	704-251-0444
Fax Number	:

Provider Business Practice Location Address
First Line	:	10221 MISTY MOSS CT
Second Line	:
City	:	MINT HILL
State	:	NC
Zip	:	28227-8121
Country	:	US
Telephone Number	:	704-251-0444
Fax Number	:

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

Provider Enumeration Date	:	08/11/2019
Last Update Date	:	04/23/2024

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