Provider Demographics
NPI:1467870600
Name:EAT TALK PLAY
Entity Type:Organization
Organization Name:EAT TALK PLAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ASQUITH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:843-388-3362
Mailing Address - Street 1:221 STALLSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-4934
Mailing Address - Country:US
Mailing Address - Phone:843-832-1795
Mailing Address - Fax:
Practice Address - Street 1:825 LOWCOUNTRY BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3063
Practice Address - Country:US
Practice Address - Phone:843-388-3362
Practice Address - Fax:843-832-9499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC793235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty