Provider Demographics
NPI:1003060112
Name:SIMMONS, DAVID (SLP)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1423 ASHLEY RIVER RD
Mailing Address - Street 2:3D
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-5368
Mailing Address - Country:US
Mailing Address - Phone:843-532-9504
Mailing Address - Fax:
Practice Address - Street 1:921 BOWMAN RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3211
Practice Address - Country:US
Practice Address - Phone:843-881-2916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3116235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist