Provider Demographics
NPI:1942918743
Name:MYERS, ANDREONA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANDREONA
Middle Name:
Last Name:MYERS
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 1:3026 N OLD RIVER RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-4201
Mailing Address - Country:US
Mailing Address - Phone:843-610-6368
Mailing Address - Fax:
Practice Address - Street 1:1002 STEEPLE RIDGE RD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-8041
Practice Address - Country:US
Practice Address - Phone:803-271-2364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5404235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist