Provider Demographics
NPI:1447004510
Name:TELESPEECHCARE
Entity type:Organization
Organization Name:TELESPEECHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PORSCHA
Authorized Official - Middle Name:XIALIA
Authorized Official - Last Name:MOUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-961-2811
Mailing Address - Street 1:717 HOLLY DR
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27205-1673
Mailing Address - Country:US
Mailing Address - Phone:704-961-2811
Mailing Address - Fax:
Practice Address - Street 1:803 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3315
Practice Address - Country:US
Practice Address - Phone:704-961-2811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1376210260OtherNPI 1