Individual
EILEEN MASTERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15133 LAKE RIDGE RD, CHARLOTTE, NC 28278-6303
(704) 249-6352
Mailing address
15133 LAKE RIDGE RD, CHARLOTTE, NC 28278-6303
(704) 249-6352
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
15489
NC
235Z00000X
Speech-Language Pathologist
Primary
6112
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6112
—
NC
05
—
6112
—
SC
Enumeration date
01/25/2013
Last updated
05/28/2026
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