1184870206 NPI number — PALMETTO SPEECH & LANGUAGE ASSOC, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184870206 NPI number — PALMETTO SPEECH & LANGUAGE ASSOC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PALMETTO SPEECH & LANGUAGE ASSOC, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184870206
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1150 HUNGRYNECK BLVD
Provider Second Line Business Mailing Address:
SUITE C-364
Provider Business Mailing Address City Name:
MOUNT PLEASANT
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29464
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-388-9990
Provider Business Mailing Address Fax Number:
843-388-0349

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3185 AZALEA DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-388-9990
Provider Business Practice Location Address Fax Number:
843-388-0349
Provider Enumeration Date:
08/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
RANDOLPH
Authorized Official First Name:
GENA
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
843-388-9990

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  3120 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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