Provider Demographics
NPI:1104193952
Name:SPEECH CONNECTION OF FLORENCE, LLC
Entity Type:Organization
Organization Name:SPEECH CONNECTION OF FLORENCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MCD/CCC
Authorized Official - Phone:843-319-0560
Mailing Address - Street 1:417 PILCHARD CT
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-5268
Mailing Address - Country:US
Mailing Address - Phone:843-319-0560
Mailing Address - Fax:843-407-4804
Practice Address - Street 1:603 BROAD ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512-4072
Practice Address - Country:US
Practice Address - Phone:843-319-0560
Practice Address - Fax:843-407-4804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA0701Medicaid