Provider Demographics
NPI: | 1346715547 |
---|---|
Name: | PALMETTO SPEECH AND SWALLOWING THERAPY, LLC |
Entity type: | Organization |
Organization Name: | PALMETTO SPEECH AND SWALLOWING THERAPY, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | SPEECH LANGUAGE PATHOLIGST |
Authorized Official - Prefix: | |
Authorized Official - First Name: | LAURA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HICKLIN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MSP, CCC-SLP |
Authorized Official - Phone: | 803-367-6109 |
Mailing Address - Street 1: | 358 LIMEHOUSE CT |
Mailing Address - Street 2: | |
Mailing Address - City: | ROCK HILL |
Mailing Address - State: | SC |
Mailing Address - Zip Code: | 29732-1880 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 803-367-6109 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 358 LIMEHOUSE CT |
Practice Address - Street 2: | |
Practice Address - City: | ROCK HILL |
Practice Address - State: | SC |
Practice Address - Zip Code: | 29732-1880 |
Practice Address - Country: | US |
Practice Address - Phone: | 803-367-6109 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2018-10-04 |
Last Update Date: | 2018-10-04 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Single Specialty |