Provider Demographics
NPI:1396989240
Name:SOUTHERN SPEECH DIAGNOSTICS PLLC
Entity type:Organization
Organization Name:SOUTHERN SPEECH DIAGNOSTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:SILER
Authorized Official - Suffix:
Authorized Official - Credentials:SLP-CCC
Authorized Official - Phone:877-773-8880
Mailing Address - Street 1:36 HIGHLAND VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-2151
Mailing Address - Country:US
Mailing Address - Phone:877-773-8880
Mailing Address - Fax:877-773-8880
Practice Address - Street 1:36 HIGHLAND VIEW DR
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-2151
Practice Address - Country:US
Practice Address - Phone:877-773-8880
Practice Address - Fax:877-773-8880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7631235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty