Provider Demographics
NPI:1326249517
Name:SUBER, IRIS SCOTT (MCD-CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:IRIS
Middle Name:SCOTT
Last Name:SUBER
Suffix:
Gender:F
Credentials:MCD-CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 DOSTAK DR
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-6606
Mailing Address - Country:US
Mailing Address - Phone:864-226-2477
Mailing Address - Fax:864-226-2477
Practice Address - Street 1:106 DOSTAK DR
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-6606
Practice Address - Country:US
Practice Address - Phone:864-226-2477
Practice Address - Fax:864-226-2477
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4059235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC591173611OtherFEDERAL TAX ID
SC190188Medicaid
SC190188Medicaid