Provider Demographics
NPI:1912401274
Name:CAROLINA SPEECH WORKS, LLC
Entity Type:Organization
Organization Name:CAROLINA SPEECH WORKS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:SCHIFANO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:317-694-6533
Mailing Address - Street 1:1218 EDBROOKE LN
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-0049
Mailing Address - Country:US
Mailing Address - Phone:803-339-3630
Mailing Address - Fax:803-281-8877
Practice Address - Street 1:975 MARKET ST STE 201D
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-6531
Practice Address - Country:US
Practice Address - Phone:803-339-3630
Practice Address - Fax:803-281-8877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-21
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4449235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1902209836OtherNPPES INDIVIDUAL NPI