MEDICARE: SPEAK, LEARN, AND PLAY

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	7342	NC

General Provider Information

NPI Number	:	1962727115
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPEAK, LEARN, AND PLAY

Provider Business Mailing Address
First Line	:	1314 PINECREST AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-6250
Country	:	US
Telephone Number	:	704-654-5250
Fax Number	:	704-469-5844

Provider Business Practice Location Address
First Line	:	1314 PINECREST AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-6250
Country	:	US
Telephone Number	:	704-654-5250
Fax Number	:	704-469-5844

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLOGIST
Name	:	JULIE MACRAE MILLER
Credential	:	MS CCC-SLP
Telephone Number	:	704-654-5250

Provider Enumeration Date	:	03/31/2010
Last Update Date	:	03/31/2010

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Directions to “SPEAK, LEARN, AND PLAY ” Practice Location

Language	Start Address	Practice Location

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