Provider Demographics
NPI:1194814517
Name:C.A.R.E. SPEECH/LANGUAGE SERVICES
Entity Type:Organization
Organization Name:C.A.R.E. SPEECH/LANGUAGE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARVA
Authorized Official - Middle Name:B
Authorized Official - Last Name:CANNION
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:843-382-8779
Mailing Address - Street 1:372 NEXSEN RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556-5138
Mailing Address - Country:US
Mailing Address - Phone:843-382-8779
Mailing Address - Fax:843-355-6297
Practice Address - Street 1:372 NEXSEN RD
Practice Address - Street 2:
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-5138
Practice Address - Country:US
Practice Address - Phone:843-382-8779
Practice Address - Fax:843-355-6297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3089235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4433Medicaid