Provider Demographics
NPI:1659990109
Name:NEW EXPRESSIONS THERAPEUTIC SERVICES
Entity Type:Organization
Organization Name:NEW EXPRESSIONS THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:CUSACK
Authorized Official - Suffix:
Authorized Official - Credentials:CCC
Authorized Official - Phone:843-409-9240
Mailing Address - Street 1:3831 W DOVER DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-7712
Mailing Address - Country:US
Mailing Address - Phone:843-409-9240
Mailing Address - Fax:888-304-1446
Practice Address - Street 1:3831 W DOVER DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-7712
Practice Address - Country:US
Practice Address - Phone:843-409-9240
Practice Address - Fax:888-304-1446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty