Individual
JANE PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
550 GLENWOOD DR, MOORESVILLE, NC 28115-2876
(704) 664-7494
Mailing address
14711 PERIDOT CT, PINEVILLE, NC 28134-9369
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
12133792
NC
Other
Enumeration date
07/17/2009
Last updated
07/17/2009
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