Provider Demographics
NPI:1194332825
Name:BRAINSTORM COGNITIVE WELLNESS AND SPEECH THERAPY
Entity type:Organization
Organization Name:BRAINSTORM COGNITIVE WELLNESS AND SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:STEPHENSON
Authorized Official - Last Name:KURY
Authorized Official - Suffix:
Authorized Official - Credentials:MSCCC-SLP
Authorized Official - Phone:704-576-4815
Mailing Address - Street 1:9212 COLIN CROSSING CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-4860
Mailing Address - Country:US
Mailing Address - Phone:704-576-4815
Mailing Address - Fax:
Practice Address - Street 1:8025 CORPORATE CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-4544
Practice Address - Country:US
Practice Address - Phone:704-576-4815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-27
Last Update Date:2020-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty