Provider Demographics
NPI:1962869883
Name:EFFECTIVE EXPRESSION L.L.C.
Entity type:Organization
Organization Name:EFFECTIVE EXPRESSION L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:WOOTEN
Authorized Official - Last Name:PRINCIPE
Authorized Official - Suffix:
Authorized Official - Credentials:MSP, CCC-SLP
Authorized Official - Phone:803-707-6248
Mailing Address - Street 1:4305 WILLINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29206-1448
Mailing Address - Country:US
Mailing Address - Phone:803-707-6248
Mailing Address - Fax:
Practice Address - Street 1:2113 ADAMS GRV
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6951
Practice Address - Country:US
Practice Address - Phone:803-707-6248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-22
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4738235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1982099909Medicaid