| Southport Speech And Language, Pllc | |
|
1746 E Coronado Ave Se, Bolivia, NC 28422-0900 | |
| (336) 404-4802 | |
| Not Available |
| Full Name | Southport Speech And Language, Pllc |
|---|---|
| Type | Facility |
| Speciality | Speech-language Pathologist |
| Location | 1746 E Coronado Ave Se, Bolivia, North Carolina |
| Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386465045 | NPI | - | NPPES |
| 1740839695 | Other | NPI | |
| 14966 | Other | NC | STATE |
| 7413660 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 235Z00000X | Speech-language Pathologist | (* (Not Available)) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Southport Speech And Language, Pllc 1746 E Coronado Ave Se, Bolivia, NC 28422-0900 Ph: (336) 404-4802 | Southport Speech And Language, Pllc 1746 E Coronado Ave Se, Bolivia, NC 28422-0900 Ph: (336) 404-4802 |
Ann M. Koehler, SLP Speech-Language Pathologist Medicare: Not Enrolled in Medicare Practice Location: 1070 Old Ocean Highway, Universal Healthcare Brunswick, Bolivia, NC 28422 Phone: 910-755-5955 | |
Laura Brown, M.ED, CCC-SLP Speech-Language Pathologist Medicare: Not Enrolled in Medicare Practice Location: 1702 Haldon Ln Se, Bolivia, NC 28422 Phone: 919-417-1311 |