MEDICARE: LAQUINTA KHALDUN 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	2776	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	:	1851457931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAQUINTA KHALDUN CCC-SLP

Provider Business Mailing Address
First Line	:	12030 BAY TREE WAY
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-5653
Country	:	US
Telephone Number	:	704-488-5104
Fax Number	:

Provider Business Practice Location Address
First Line	:	2101 SARDIS RD N
Second Line	:	STE 112
City	:	CHARLOTTE
State	:	NC
Zip	:	28227-7711
Country	:	US
Telephone Number	:	704-845-6134
Fax Number	:

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

Provider Enumeration Date	:	12/31/2006
Last Update Date	:	07/09/2007

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Directions to “ LAQUINTA KHALDUN CCC-SLP” Practice Location

Language	Start Address	Practice Location

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