Provider Demographics
NPI:1063586493
Name:PALMETTO LANGUAGE & SPEECH CENTER, LLC
Entity type:Organization
Organization Name:PALMETTO LANGUAGE & SPEECH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CENTER DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:K
Authorized Official - Last Name:MARANVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:MSP, CCC-SLP
Authorized Official - Phone:803-356-9833
Mailing Address - Street 1:109 A VISTA OAKS DRIVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072
Mailing Address - Country:US
Mailing Address - Phone:803-356-9833
Mailing Address - Fax:803-996-0548
Practice Address - Street 1:109 A VISTA OAKS DRIVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072
Practice Address - Country:US
Practice Address - Phone:803-356-9833
Practice Address - Fax:803-996-0548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1522235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSAO175Medicaid
SC1740381573OtherINDIVIDUAL NPI NUMBER