Provider Demographics
NPI:1669644662
Name:PITTARD, CAROLINE HOLLEY (CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:CAROLINE
Middle Name:HOLLEY
Last Name:PITTARD
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 1:132 TYVOLA DRIVE
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8333
Mailing Address - Country:US
Mailing Address - Phone:843-270-7231
Mailing Address - Fax:843-879-3967
Practice Address - Street 1:132 TYVOLA DRIVE
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8333
Practice Address - Country:US
Practice Address - Phone:843-270-7231
Practice Address - Fax:843-879-3967
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4029235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA0882Medicaid