Provider Demographics
NPI:1942654397
Name:BASNETT, MARY KATHERINE (MA CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:MARY
Middle Name:KATHERINE
Last Name:BASNETT
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2113 ADAMS GRV STE 201
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6957
Mailing Address - Country:US
Mailing Address - Phone:803-404-7963
Mailing Address - Fax:
Practice Address - Street 1:2113 ADAMS GRV STE 201
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6957
Practice Address - Country:US
Practice Address - Phone:803-404-7963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5681235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist