Provider Demographics
NPI:1902613714
Name:CAROLINA SPEECH WORKS
Entity type:Organization
Organization Name:CAROLINA SPEECH WORKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOURNET KOVERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:803-984-5156
Mailing Address - Street 1:1245 ROSEMONT DR STE 115
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29707-7765
Mailing Address - Country:US
Mailing Address - Phone:803-281-0185
Mailing Address - Fax:
Practice Address - Street 1:1245 ROSEMONT DR STE 115
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29707-7765
Practice Address - Country:US
Practice Address - Phone:803-281-0185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech