Provider Demographics
NPI:1578924213
Name:NELSON, MARYANN DENISE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARYANN
Middle Name:DENISE
Last Name:NELSON
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 1:300 REGENCY RD
Mailing Address - Street 2:APT Q7
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-1800
Mailing Address - Country:US
Mailing Address - Phone:864-921-4333
Mailing Address - Fax:
Practice Address - Street 1:1057 POINTER DR
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-5865
Practice Address - Country:US
Practice Address - Phone:864-921-4333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5213235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist