Pediatric Speech Language Therapy, PLLC

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

License

11106 Issued in NC

Legal business name

PEDIATRIC SPEECH LANGUAGE THERAPY, PLLC

Practice address

1216 Crescent Dr
Elizabeth City, NC 27909-6652

Phone

(252) 339-8145

Fax

(252) 338-9156

NPI assigned

Nov 4, 2014

Organization subpart

No

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

Authorized official

Name

Mrs. Rebecca Soldan Broadfoot, MA,CCC-SLP

Title

Speech-Language Pathologist

Phone

(252) 339-8145

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1415059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415059200000",
    "number": "1770988669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1216 CRESCENT DR",
            "city": "ELIZABETH CITY",
            "state": "NC",
            "postal_code": "279096652",
            "telephone_number": "252-339-8145",
            "fax_number": "252-338-9156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1216 CRESCENT DR",
            "city": "ELIZABETH CITY",
            "state": "NC",
            "postal_code": "279096652",
            "telephone_number": "252-339-8145",
            "fax_number": "252-338-9156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC SPEECH LANGUAGE THERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-04",
        "last_updated": "2014-11-04",
        "status": "A",
        "authorized_official_last_name": "BROADFOOT",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_middle_name": "SOLDAN",
        "authorized_official_title_or_position": "SPEECH-LANGUAGE PATHOLOGIST",
        "authorized_official_telephone_number": "252-339-8145",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MA,CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "NC",
            "license": "11106",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Developmentally Disabled Services Day Training Agency in Elizabeth City, NC
• Providers in Elizabeth City, NC by specialty
• Developmentally Disabled Services Day Training Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2014; 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.