Provider Demographics
NPI:1790054443
Name:SPEECH AND LANGUAGE THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:SPEECH AND LANGUAGE THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ABUSHAKRA
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC/SLP
Authorized Official - Phone:843-491-3572
Mailing Address - Street 1:1016 2ND AVE N STE 102
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-3287
Mailing Address - Country:US
Mailing Address - Phone:843-491-3572
Mailing Address - Fax:843-491-3573
Practice Address - Street 1:1016 2ND AVE N STE 102
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-3287
Practice Address - Country:US
Practice Address - Phone:843-491-3572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-27
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech