Provider Demographics
NPI:1851177703
Name:AS WE SPEECH THERAPY SERVICES
Entity Type:Organization
Organization Name:AS WE SPEECH THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:CF-SLP
Authorized Official - Phone:980-255-0200
Mailing Address - Street 1:140 BROOKDALE ACRES DR
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29365-9793
Mailing Address - Country:US
Mailing Address - Phone:980-255-0200
Mailing Address - Fax:
Practice Address - Street 1:140 BROOKDALE ACRES DR
Practice Address - Street 2:
Practice Address - City:LYMAN
Practice Address - State:SC
Practice Address - Zip Code:29365-9793
Practice Address - Country:US
Practice Address - Phone:980-255-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty