Provider Demographics
NPI:1689817629
Name:COX, CHARLOTTE R (MCD CCC SLP)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:R
Last Name:COX
Suffix:
Gender:F
Credentials:MCD CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 HIGHWAY 41 S
Mailing Address - Street 2:
Mailing Address - City:LAKE VIEW
Mailing Address - State:SC
Mailing Address - Zip Code:29563-5590
Mailing Address - Country:US
Mailing Address - Phone:843-759-0205
Mailing Address - Fax:
Practice Address - Street 1:2323 HIGHWAY 41 S
Practice Address - Street 2:
Practice Address - City:LAKE VIEW
Practice Address - State:SC
Practice Address - Zip Code:29563-5590
Practice Address - Country:US
Practice Address - Phone:843-759-0205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-07
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3975235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist