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Organization
PEDIATRIC FEEDING AND SPEECH THERAPY ASSOCIATES, PA
Active
Organization
PEDIATRIC FEEDING AND SPEECH THERAPY ASSOCIATES, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLEN MOWERS (VICE PRESIDENT)
(704) 619-2167
Entity
Organization
Contact information
Practice address
8820 BLOOMING ARBOR ST, HUNTERSVILLE, NC 28078-5602
(704) 619-2167
(704) 948-6963
Mailing address
PO BOX 601, HUNTERSVILLE, NC 28070-0601
(704) 619-2167
(704) 948-6963
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
4252
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1060C
BLUE CROSS & BLUE SHIELD
NC
05
—
741060C
—
NC
Enumeration date
11/18/2006
Last updated
08/22/2020
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