Provider Demographics
NPI:1124433883
Name:GREENVILLE BILINGUAL THERAPY
Entity type:Organization
Organization Name:GREENVILLE BILINGUAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARI-COLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-361-4879
Mailing Address - Street 1:511 FULTON CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4480
Mailing Address - Country:US
Mailing Address - Phone:864-361-4879
Mailing Address - Fax:972-616-5203
Practice Address - Street 1:511 FULTON CT
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4480
Practice Address - Country:US
Practice Address - Phone:864-361-4879
Practice Address - Fax:972-616-5203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5111261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA1415Medicaid