Provider Demographics
NPI:1871824573
Name:CHATTERKIDZ SPEECH AND LANGUAGE THERAPY, LLC
Entity Type:Organization
Organization Name:CHATTERKIDZ SPEECH AND LANGUAGE THERAPY, LLC
Other - Org Name:WILLIAMSBURG SPEECH LANGUAGE THERAPY SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESSIE
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:843-382-7641
Mailing Address - Street 1:1253 GAUSETOWN RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556-7491
Mailing Address - Country:US
Mailing Address - Phone:843-382-7641
Mailing Address - Fax:843-382-7651
Practice Address - Street 1:1253 GAUSETOWN RD
Practice Address - Street 2:
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-7491
Practice Address - Country:US
Practice Address - Phone:843-382-7641
Practice Address - Fax:843-382-7651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-19
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3029235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1154473973Medicaid