Provider Demographics
NPI:1427088681
Name:SPEECHSOUTH, INC.
Entity type:Organization
Organization Name:SPEECHSOUTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:MORTON
Authorized Official - Last Name:HARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:704-370-2767
Mailing Address - Street 1:718 W TRADE ST
Mailing Address - Street 2:STE 514
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-1339
Mailing Address - Country:US
Mailing Address - Phone:704-370-2767
Mailing Address - Fax:704-370-2926
Practice Address - Street 1:718 W TRADE ST
Practice Address - Street 2:STE 514
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-1339
Practice Address - Country:US
Practice Address - Phone:704-370-2767
Practice Address - Fax:704-370-2926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6798235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7212053Medicaid