Provider Demographics
NPI:1164622437
Name:GREENE, GINA BROWN (MSP, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:BROWN
Last Name:GREENE
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 1:46 LAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-6962
Mailing Address - Country:US
Mailing Address - Phone:843-343-6712
Mailing Address - Fax:
Practice Address - Street 1:46 LAMPTON RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-6962
Practice Address - Country:US
Practice Address - Phone:843-343-6712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2753235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA0234Medicaid