Provider Demographics
NPI:1114984937
Name:AITCHISON, MARY J (PHD)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:J
Last Name:AITCHISON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:J
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSP
Mailing Address - Street 1:2 MEDICAL PARK RD
Mailing Address - Street 2:SUITE 402
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6808
Mailing Address - Country:US
Mailing Address - Phone:803-256-2657
Mailing Address - Fax:803-434-7349
Practice Address - Street 1:2 MEDICAL PARK RD
Practice Address - Street 2:SUITE 302
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6808
Practice Address - Country:US
Practice Address - Phone:803-256-2657
Practice Address - Fax:803-434-7349
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2882235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA0334Medicaid