Organization
BRAVE ROOTS SPEECH THERAPY PLLC
Active
Other names
Brave Roots Speech Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELYN VORNDRAN (SLP)
(919) 907-0849
Entity
Organization
Contact information
Practice address
4405 LIVE OAK TRL, DURHAM, NC 27705-9606
(919) 907-0849
Mailing address
4405 LIVE OAK TRL, DURHAM, NC 27705-9606
(919) 907-0849
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1427572304
—
NC
Enumeration date
05/24/2021
Last updated
05/24/2021
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