Provider Demographics
NPI:1689793671
Name:PITTMAN, LINDA QUICK (MA,CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:QUICK
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:452 ROGERS DR
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-2107
Mailing Address - Country:US
Mailing Address - Phone:803-535-0635
Mailing Address - Fax:803-534-2450
Practice Address - Street 1:452 ROGERS DR
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-2107
Practice Address - Country:US
Practice Address - Phone:803-535-0635
Practice Address - Fax:803-534-2450
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3644235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA0588Medicaid