MEDICARE: UNITED SLP, PLLC

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	:	1508450644
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED SLP, PLLC

Provider Business Mailing Address
First Line	:	9805 STATESVILLE RD STE 4150
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-7647
Country	:	US
Telephone Number	:	910-527-3086
Fax Number	:

Provider Business Practice Location Address
First Line	:	9805 STATESVILLE RD STE 4150
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-7647
Country	:	US
Telephone Number	:	910-527-3086
Fax Number	:

Authorized Official
Title or Position	:	SPEECH-LANGUAGE PATHOLOGIST
Name	:	LOGAN D CARTER
Credential	:	CCC-SLP
Telephone Number	:	910-527-3086

Provider Enumeration Date	:	03/01/2021
Last Update Date	:	03/01/2021

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