Provider Demographics
NPI:1619422201
Name:TALSMA, JOSCELYN
Entity Type:Individual
Prefix:
First Name:JOSCELYN
Middle Name:
Last Name:TALSMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DAVIDSON DR
Mailing Address - Street 2:
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-3307
Mailing Address - Country:US
Mailing Address - Phone:843-797-2711
Mailing Address - Fax:
Practice Address - Street 1:100 DAVIDSON DR
Practice Address - Street 2:
Practice Address - City:LADSON
Practice Address - State:SC
Practice Address - Zip Code:29456-3307
Practice Address - Country:US
Practice Address - Phone:843-797-2711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101004231235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist