MEDICARE: SALTWATER SPEECH THERAPY, PC

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	7149	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	:	1427397967
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALTWATER SPEECH THERAPY, PC

Provider Business Mailing Address
First Line	:	PO BOX 220
Second Line	:
City	:	HAMPSTEAD
State	:	NC
Zip	:	28443-0220
Country	:	US
Telephone Number	:	910-541-1404
Fax Number	:	910-329-4445

Provider Business Practice Location Address
First Line	:	624 US HIGHWAY 17 S
Second Line	:	SUITE 5
City	:	HOLLY RIDGE
State	:	NC
Zip	:	28445-8660
Country	:	US
Telephone Number	:	910-541-1404
Fax Number	:	910-329-4445

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLOGIST
Name	:	MRS. CHRISTIE L KERN
Credential	:	M.S.
Telephone Number	:	910-541-1404

Provider Enumeration Date	:	02/04/2013
Last Update Date	:	02/04/2013

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Directions to “SALTWATER SPEECH THERAPY, PC ” Practice Location

Language	Start Address	Practice Location

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