# WAKE PEDIATRIC SPEECH THERAPY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366860546
- **Authorized official:** CHRISTINA JOHNSON MS, CCC-SLP (SPEECH PATHOLOGIST/OWNER)
- **Authorized official phone:** (919) 593-8104

## Contact information

- **Practice address:** 1157 EXECUTIVE CIR STE B1, CARY, NC 27511-4579
- **Practice address phone:** (919) 593-8104
- **Practice address fax:** (919) 882-8110
- **Mailing address:** 1157 EXECUTIVE CIR STE B1, CARY, NC 27511-4579
- **Mailing address phone:** (919) 593-8104
- **Mailing address fax:** (919) 882-8110

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QH0700X | Hearing and Speech Clinic/Center | 5439 | NC | Yes |

## Other

- **Enumeration date:** 04/03/2014
- **Last updated:** 04/03/2014