Provider Demographics
NPI:1710304639
Name:PALMETTO PEDIATRIC SPEECH THERAPY LLC
Entity Type:Organization
Organization Name:PALMETTO PEDIATRIC SPEECH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER,SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:STRICKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MSP, CCC-SLP
Authorized Official - Phone:864-940-8639
Mailing Address - Street 1:205B CONCORD RD
Mailing Address - Street 2:APT/SUITE
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-2731
Mailing Address - Country:US
Mailing Address - Phone:864-940-8639
Mailing Address - Fax:864-752-1308
Practice Address - Street 1:205B CONCORD RD
Practice Address - Street 2:APT/SUITE
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-2731
Practice Address - Country:US
Practice Address - Phone:864-940-8639
Practice Address - Fax:864-752-1308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4253235Z00000X
SC3922235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty