Provider Demographics
NPI:1801627104
Name:SALT AND LIGHT SPEECH THERAPY, PLLC
Entity type:Organization
Organization Name:SALT AND LIGHT SPEECH THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DORI
Authorized Official - Middle Name:FAULK
Authorized Official - Last Name:HEWETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-840-4854
Mailing Address - Street 1:1005 BAY RD SW
Mailing Address - Street 2:
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28470-5341
Mailing Address - Country:US
Mailing Address - Phone:910-840-4854
Mailing Address - Fax:
Practice Address - Street 1:1005 BAY RD SW
Practice Address - Street 2:
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-5341
Practice Address - Country:US
Practice Address - Phone:910-840-4854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist