Provider Demographics
NPI:1255987251
Name:THORP, DYLAN LOUISE (SLP)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:LOUISE
Last Name:THORP
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4548
Mailing Address - Country:US
Mailing Address - Phone:843-860-7098
Mailing Address - Fax:
Practice Address - Street 1:414 SUMMIT DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-4821
Practice Address - Country:US
Practice Address - Phone:864-414-8898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist