Provider Demographics
NPI:1376195503
Name:HYATT, DEMETRIA RAQUEL (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:DEMETRIA
Middle Name:RAQUEL
Last Name:HYATT
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 DALMORE CT
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016
Mailing Address - Country:US
Mailing Address - Phone:843-295-5363
Mailing Address - Fax:
Practice Address - Street 1:1002 STEEPLE RIDGE RD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063
Practice Address - Country:US
Practice Address - Phone:803-271-2364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-09
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist