Provider Demographics
NPI:1689291783
Name:BLYTHEWOOD SPEECH THERAPY
Entity Type:Organization
Organization Name:BLYTHEWOOD SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:803-404-1175
Mailing Address - Street 1:156 COATBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-9168
Mailing Address - Country:US
Mailing Address - Phone:803-404-1175
Mailing Address - Fax:
Practice Address - Street 1:156 COATBRIDGE DR
Practice Address - Street 2:
Practice Address - City:BLYTHEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29016-9168
Practice Address - Country:US
Practice Address - Phone:803-404-1175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty