Provider Demographics
NPI:1902830177
Name:CAROLINA SPEECH CONNECTION, LLC
Entity Type:Organization
Organization Name:CAROLINA SPEECH CONNECTION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGAUGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:STEFFAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCC/SLP
Authorized Official - Phone:803-389-1175
Mailing Address - Street 1:9789 CHARLOTTE HWY
Mailing Address - Street 2:SUITE 400, BOX #249
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-7177
Mailing Address - Country:US
Mailing Address - Phone:803-389-1175
Mailing Address - Fax:803-547-2115
Practice Address - Street 1:9789 CHARLOTTE HWY
Practice Address - Street 2:SUITE 400, BOX #249
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-7177
Practice Address - Country:US
Practice Address - Phone:803-389-1175
Practice Address - Fax:803-547-2115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3966235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA0719Medicaid