Provider Demographics
NPI:1184314585
Name:PEMBERTON, SYDNEY (MSP, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:PEMBERTON
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 LOWNDES HILL RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-1322
Mailing Address - Country:US
Mailing Address - Phone:865-809-9851
Mailing Address - Fax:
Practice Address - Street 1:128 CAPERS ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-2805
Practice Address - Country:US
Practice Address - Phone:864-205-3754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6129235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist