Provider Demographics
NPI:1396428470
Name:CEDAR & VINE PEDIATRIC THERAPY
Entity type:Organization
Organization Name:CEDAR & VINE PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:FAITH
Authorized Official - Last Name:BANE
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:980-230-2555
Mailing Address - Street 1:1183 CITADEL AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6779
Mailing Address - Country:US
Mailing Address - Phone:980-230-2555
Mailing Address - Fax:
Practice Address - Street 1:1183 CITADEL AVE
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6779
Practice Address - Country:US
Practice Address - Phone:980-230-2555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech