Provider Demographics
NPI:1538682471
Name:HUTCHINSON, ELAN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELAN
Middle Name:
Last Name:HUTCHINSON
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 1:10825 DORCHESTER RD APT 3047
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-6072
Mailing Address - Country:US
Mailing Address - Phone:904-304-0057
Mailing Address - Fax:
Practice Address - Street 1:320 N LIVE OAK DR
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-3696
Practice Address - Country:US
Practice Address - Phone:184-389-9880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6281235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist