Provider Demographics
NPI:1275353401
Name:PREMIER SPEECH THERAPY, LLC
Entity type:Organization
Organization Name:PREMIER SPEECH THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERDRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-873-4981
Mailing Address - Street 1:528 BATTERY PARK RD
Mailing Address - Street 2:
Mailing Address - City:NESMITH
Mailing Address - State:SC
Mailing Address - Zip Code:29580-3046
Mailing Address - Country:US
Mailing Address - Phone:803-873-4981
Mailing Address - Fax:
Practice Address - Street 1:528 BATTERY PARK RD
Practice Address - Street 2:
Practice Address - City:NESMITH
Practice Address - State:SC
Practice Address - Zip Code:29580-3046
Practice Address - Country:US
Practice Address - Phone:803-873-4981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty