Provider Demographics
NPI:1780834317
Name:FISCUS, TIMOTHY PAUL (MSR, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:PAUL
Last Name:FISCUS
Suffix:
Gender:M
Credentials:MSR, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2508 MELVILLE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9798
Mailing Address - Country:US
Mailing Address - Phone:843-810-3933
Mailing Address - Fax:
Practice Address - Street 1:2508 MELVILLE RD
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9798
Practice Address - Country:US
Practice Address - Phone:843-810-3933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3841235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist