Provider Demographics
NPI:1326228644
Name:MEANS, EBONY (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:EBONY
Middle Name:
Last Name:MEANS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 KENMORE PARK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-8253
Mailing Address - Country:US
Mailing Address - Phone:803-319-7529
Mailing Address - Fax:
Practice Address - Street 1:229 KENMORE PARK DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-8253
Practice Address - Country:US
Practice Address - Phone:803-319-7529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4882235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA1432Medicaid
SCGP8198Medicaid