Provider Demographics
NPI:1376848127
Name:AYCOCK, NANETTE F
Entity Type:Individual
Prefix:
First Name:NANETTE
Middle Name:F
Last Name:AYCOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 MAPLE BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:REEVESVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29471-5012
Mailing Address - Country:US
Mailing Address - Phone:843-563-5407
Mailing Address - Fax:
Practice Address - Street 1:519 MAPLE BRANCH RD
Practice Address - Street 2:
Practice Address - City:REEVESVILLE
Practice Address - State:SC
Practice Address - Zip Code:29471-5012
Practice Address - Country:US
Practice Address - Phone:843-563-5407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4690235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist