Provider Demographics
NPI:1508189432
Name:NORTHEAST SPEECH-LANGUAGE PATHOLOGY, LLC (NESLP)
Entity Type:Organization
Organization Name:NORTHEAST SPEECH-LANGUAGE PATHOLOGY, LLC (NESLP)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LASHAWN
Authorized Official - Middle Name:C
Authorized Official - Last Name:THOMAS BRIDGES
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC/SLP
Authorized Official - Phone:803-429-2327
Mailing Address - Street 1:P.O. BOX 290302
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229
Mailing Address - Country:US
Mailing Address - Phone:803-260-6471
Mailing Address - Fax:803-865-6045
Practice Address - Street 1:576 ANSON DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7422
Practice Address - Country:US
Practice Address - Phone:803-865-6045
Practice Address - Fax:803-865-6045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-06
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2673235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty