Provider Demographics
NPI:1316130628
Name:ROYAL, NELL GARDENHIRE (MA-CCC/SLP)
Entity type:Individual
Prefix:MS
First Name:NELL
Middle Name:GARDENHIRE
Last Name:ROYAL
Suffix:
Gender:F
Credentials:MA-CCC/SLP
Other - Prefix:MS
Other - First Name:NELL
Other - Middle Name:RASHAWN
Other - Last Name:GARDENHIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA-CCC/SLP
Mailing Address - Street 1:11026 AMBERGLADES LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-8608
Mailing Address - Country:US
Mailing Address - Phone:704-491-2068
Mailing Address - Fax:
Practice Address - Street 1:11026 AMBERGLADES LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-8608
Practice Address - Country:US
Practice Address - Phone:704-491-2068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7167235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist