Provider Demographics
NPI:1467224287
Name:DAVIDSON, SANDRA SUE (MA; CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:SUE
Last Name:DAVIDSON
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 1:455 TANYARD TRCE
Mailing Address - Street 2:
Mailing Address - City:PROSPERITY
Mailing Address - State:SC
Mailing Address - Zip Code:29127-7189
Mailing Address - Country:US
Mailing Address - Phone:803-226-8788
Mailing Address - Fax:
Practice Address - Street 1:455 TANYARD TRCE
Practice Address - Street 2:
Practice Address - City:PROSPERITY
Practice Address - State:SC
Practice Address - Zip Code:29127-7189
Practice Address - Country:US
Practice Address - Phone:803-226-8788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3398235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist