Organization Name: | MY BLUE SKY, PC |
NPI Number: | 1124323381 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MEREDITH L BROUGHTON (OWNER/ LEAD PATHOLOGIST) |
Mailing Address: | 3419b Melrose Rd Fayetteville |
State: | NC US |
Postal Code: | 283041608 |
Phone Number: | 9102572005 |
Fax Number: | 9104856315 |
NPI Enumeration Date: | 01/20/2011 |
NPI Last Update Date: | 10/08/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 6694 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |