Provider Demographics
NPI:1801184585
Name:FARMER, PHYLLIS ALLEN (MED CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:ALLEN
Last Name:FARMER
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 WEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-3818
Mailing Address - Country:US
Mailing Address - Phone:864-430-2431
Mailing Address - Fax:
Practice Address - Street 1:36 WEDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-3818
Practice Address - Country:US
Practice Address - Phone:864-430-2431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-15
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC604235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist