Provider Demographics
NPI:1952684433
Name:COX SPEECH-LANGUAGE PATHOLOGY, INC.
Entity Type:Organization
Organization Name:COX SPEECH-LANGUAGE PATHOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/SLP
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:R
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:MCD, CCC-SLP
Authorized Official - Phone:843-759-0205
Mailing Address - Street 1:2323 HIGHWAY 41 S
Mailing Address - Street 2:
Mailing Address - City:LAKE VIEW
Mailing Address - State:SC
Mailing Address - Zip Code:29563-5590
Mailing Address - Country:US
Mailing Address - Phone:843-759-0205
Mailing Address - Fax:
Practice Address - Street 1:108 N MAULDIN ST
Practice Address - Street 2:
Practice Address - City:LATTA
Practice Address - State:SC
Practice Address - Zip Code:29565-1319
Practice Address - Country:US
Practice Address - Phone:843-713-1677
Practice Address - Fax:843-418-3011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3975235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1689817629OtherINDIVIDUAL NPI
SCSA0972Medicaid