Provider Demographics
NPI:1063545796
Name:SOUTH COUNTY SPEECH AND LANGUAGE CENTER
Entity type:Organization
Organization Name:SOUTH COUNTY SPEECH AND LANGUAGE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:CONNORS
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:401-295-5995
Mailing Address - Street 1:420 SCRABBLETOWN RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-3638
Mailing Address - Country:US
Mailing Address - Phone:401-295-5995
Mailing Address - Fax:401-295-8700
Practice Address - Street 1:420 SCRABBLETOWN RD
Practice Address - Street 2:SUITE H
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-3638
Practice Address - Country:US
Practice Address - Phone:401-295-5995
Practice Address - Fax:401-295-8700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP00269235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI10428OtherNEIGHBORHOOD HEALTH PLAN
RI22409-3Medicare UPIN
RI10428OtherNEIGHBORHOOD HEALTH PLAN
RI407374Medicare UPIN