Provider Demographics
NPI:1760658660
Name:JUST SPEECHY
Entity Type:Organization
Organization Name:JUST SPEECHY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST/ OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MED-CCC-SLP
Authorized Official - Phone:864-764-5863
Mailing Address - Street 1:407 CAPERTON WAY
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:SC
Mailing Address - Zip Code:29334-8966
Mailing Address - Country:US
Mailing Address - Phone:864-764-5863
Mailing Address - Fax:864-486-1686
Practice Address - Street 1:407 CAPERTON WAY
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:SC
Practice Address - Zip Code:29334-8966
Practice Address - Country:US
Practice Address - Phone:864-764-5863
Practice Address - Fax:864-486-1686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4018235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1912031717Medicaid