Provider Demographics
NPI:1992971741
Name:COASTAL SPEECH SERVICES,INC.
Entity type:Organization
Organization Name:COASTAL SPEECH SERVICES,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:WARRICK
Authorized Official - Last Name:MCROY
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:336-736-3907
Mailing Address - Street 1:1246 CABLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27205-2328
Mailing Address - Country:US
Mailing Address - Phone:336-953-2105
Mailing Address - Fax:336-736-3907
Practice Address - Street 1:1246 CABLE CREEK RD
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27205-2328
Practice Address - Country:US
Practice Address - Phone:336-953-2105
Practice Address - Fax:336-736-3907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3283235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7200161Medicaid