Provider Demographics
NPI:1790109650
Name:CAROLINA SPEECH PATHOLOGY SERVICES LLC
Entity Type:Organization
Organization Name:CAROLINA SPEECH PATHOLOGY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:843-419-7576
Mailing Address - Street 1:106 CEDAR GROVE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29420-8146
Mailing Address - Country:US
Mailing Address - Phone:843-419-7576
Mailing Address - Fax:843-552-5122
Practice Address - Street 1:350 E WASHINGTON ST UNIT C
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-3982
Practice Address - Country:US
Practice Address - Phone:843-419-7576
Practice Address - Fax:843-552-5122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC969261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech