Provider Demographics
NPI:1033406541
Name:CLELLAND, CARLSON COLE (MSP, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CARLSON
Middle Name:COLE
Last Name:CLELLAND
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:779 GLENDALYN AVE
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-1402
Mailing Address - Country:US
Mailing Address - Phone:864-244-3474
Mailing Address - Fax:
Practice Address - Street 1:420 THE PKWY STE M
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-5205
Practice Address - Country:US
Practice Address - Phone:864-244-3474
Practice Address - Fax:864-244-3475
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4741235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist