Provider Demographics
NPI:1215474812
Name:EXPRESS YOURSELF, NC
Entity type:Organization
Organization Name:EXPRESS YOURSELF, NC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FENWICK
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:484-883-2481
Mailing Address - Street 1:204 NEW RAIL DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-2722
Mailing Address - Country:US
Mailing Address - Phone:484-883-2481
Mailing Address - Fax:919-336-4515
Practice Address - Street 1:204 NEW RAIL DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-2722
Practice Address - Country:US
Practice Address - Phone:484-883-2481
Practice Address - Fax:919-336-4515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-21
Last Update Date:2017-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9445235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1396036927Medicaid