Provider Demographics
NPI:1083629505
Name:HUBBARD, TEKEITHA MICHELE (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:TEKEITHA
Middle Name:MICHELE
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12021 CHEVIOTT HILL LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-3895
Mailing Address - Country:US
Mailing Address - Phone:704-455-6375
Mailing Address - Fax:704-455-5942
Practice Address - Street 1:12021 CHEVIOTT HILL LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-3895
Practice Address - Country:US
Practice Address - Phone:704-455-6375
Practice Address - Fax:704-455-5942
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5666235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC9862Medicaid