Provider Demographics
NPI:1588874184
Name:MILESTONES SPEECH AND LANGUAGE LLC
Entity type:Organization
Organization Name:MILESTONES SPEECH AND LANGUAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAKISHA
Authorized Official - Middle Name:LATHAN
Authorized Official - Last Name:TRUESDALE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:803-235-6061
Mailing Address - Street 1:PO BOX 2795
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29721-2795
Mailing Address - Country:US
Mailing Address - Phone:803-283-6318
Mailing Address - Fax:803-753-9162
Practice Address - Street 1:304 NORTH WHITE STREET
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720
Practice Address - Country:US
Practice Address - Phone:803-283-6318
Practice Address - Fax:803-753-9162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6556235Z00000X
SC3686235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412209Medicaid
SCSA0607Medicaid