Provider Demographics
NPI:1063930782
Name:FARWELL, OPAL ANNA (SLP, MA-CCC)
Entity type:Individual
Prefix:
First Name:OPAL
Middle Name:ANNA
Last Name:FARWELL
Suffix:
Gender:F
Credentials:SLP, MA-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:WALHALLA
Mailing Address - State:SC
Mailing Address - Zip Code:29691-2146
Mailing Address - Country:US
Mailing Address - Phone:864-886-4400
Mailing Address - Fax:
Practice Address - Street 1:225 COFFEE RD
Practice Address - Street 2:
Practice Address - City:WALHALLA
Practice Address - State:SC
Practice Address - Zip Code:29691-1777
Practice Address - Country:US
Practice Address - Phone:864-886-4470
Practice Address - Fax:864-886-4471
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6335235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist