Provider Demographics
NPI:1194059295
Name:CAROLINA SPEECH AND LANGUAGE ASSOCIATES, LLC
Entity type:Organization
Organization Name:CAROLINA SPEECH AND LANGUAGE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LATRICE
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MA,SLP-CCC
Authorized Official - Phone:803-928-0369
Mailing Address - Street 1:PO BOX 1932
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29116-1932
Mailing Address - Country:US
Mailing Address - Phone:803-928-0369
Mailing Address - Fax:866-524-1024
Practice Address - Street 1:3298 HUNTER DRIVE
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-2017
Practice Address - Country:US
Practice Address - Phone:803-928-0369
Practice Address - Fax:866-524-1024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-23
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA0518Medicaid