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Organization
SOUTHPORT SPEECH AND LANGUAGE, PLLC
Active
Organization
SOUTHPORT SPEECH AND LANGUAGE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA ANN MCDANIEL O'CONNELL SLP (OWNER)
(336) 404-4802
Entity
Organization
Contact information
Practice address
1746 E CORONADO AVE SE, BOLIVIA, NC 28422-0900
(336) 404-4802
Mailing address
1746 E CORONADO AVE SE, BOLIVIA, NC 28422-0900
(336) 404-4802
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14966
STATE
NC
01
—
1740839695
NPI
—
05
—
7413660
—
NC
Enumeration date
10/24/2024
Last updated
10/24/2024
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