Provider Demographics
NPI:1629161997
Name:HINES, EDITH H (MSP, CCC-SP)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:H
Last Name:HINES
Suffix:
Gender:F
Credentials:MSP, CCC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 HAMPTON TRACE LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-1916
Mailing Address - Country:US
Mailing Address - Phone:803-622-8851
Mailing Address - Fax:
Practice Address - Street 1:305 HAMPTON TRACE LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1916
Practice Address - Country:US
Practice Address - Phone:803-622-8851
Practice Address - Fax:803-622-8851
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3596235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist