Southport Speech and Language, PLLC

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Legal business name

SOUTHPORT SPEECH AND LANGUAGE, PLLC

Practice address

1746 E Coronado Ave SE
Bolivia, NC 28422-0900

Phone

(336) 404-4802

NPI assigned

Oct 24, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Laura Ann McDaniel O'Connell, SLP

Title

Owner

Phone

(336) 404-4802

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Laura Ann McDaniel O'Connell, SLP

  • Speech-Language Pathologist
  • Bolivia, NC
  • NPI 1740839695
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1729728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729728000000",
    "number": "1386465045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1746 E CORONADO AVE SE",
            "city": "BOLIVIA",
            "state": "NC",
            "postal_code": "284220900",
            "telephone_number": "336-404-4802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1746 E CORONADO AVE SE",
            "city": "BOLIVIA",
            "state": "NC",
            "postal_code": "284220900",
            "telephone_number": "336-404-4802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHPORT SPEECH AND LANGUAGE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-24",
        "last_updated": "2024-10-24",
        "certification_date": "2024-10-24",
        "status": "A",
        "authorized_official_last_name": "O'CONNELL",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "ANN MCDANIEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "336-404-4802",
        "authorized_official_credential": "SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1740839695",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE",
            "identifier": "14966",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7413660",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• William Sherrod, M.D.
• Jennifer E Skladanowski, MA, CCC-SLP
• Alison Slomba, OTR/L
• Joseph Andrew Smith
• Victoria Edwards Smith, OBNP
• Abigail Rose Squires, FNP-BC
• Shea Elisabeth Stewart, CNM
• Heather Locklear Strickland, MA,LCMHCS, LCAS
• Courtney Anne Strubin
• Sunset Harbor Psychiatric Services, PLLC

• Speech-Language Pathologist in Bolivia, NC
• Providers in Bolivia, NC by specialty
• Speech-Language Pathologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.