Provider Demographics
NPI:1972707420
Name:DELOATCH, CHRISTINE DENESE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:DENESE
Last Name:DELOATCH
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DUNOON CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-9293
Mailing Address - Country:US
Mailing Address - Phone:803-206-4576
Mailing Address - Fax:
Practice Address - Street 1:1 DUNOON CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-9293
Practice Address - Country:US
Practice Address - Phone:803-206-4576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4810235Z00000X
NC4587235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist