Provider Demographics
NPI:1366058851
Name:SHORTRIDGE SPEECH AND LANGUAGE PLLC
Entity type:Organization
Organization Name:SHORTRIDGE SPEECH AND LANGUAGE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:COLE
Authorized Official - Last Name:SHORTRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:336-420-1899
Mailing Address - Street 1:1949 US 221 HWY N
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORDTON
Mailing Address - State:NC
Mailing Address - Zip Code:28139-6607
Mailing Address - Country:US
Mailing Address - Phone:336-420-1899
Mailing Address - Fax:
Practice Address - Street 1:1949 US 221 HWY N
Practice Address - Street 2:
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139-6607
Practice Address - Country:US
Practice Address - Phone:336-420-1899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-20
Last Update Date:2020-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty