Provider Demographics
NPI:1356568703
Name:VAN GIESEN, TODD JAMES (SLP)
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:JAMES
Last Name:VAN GIESEN
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 1:427 GLENSPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-9269
Mailing Address - Country:US
Mailing Address - Phone:828-684-2735
Mailing Address - Fax:
Practice Address - Street 1:1941 SAVAGE RD
Practice Address - Street 2:SUITE 400C
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4704
Practice Address - Country:US
Practice Address - Phone:843-571-2700
Practice Address - Fax:843-571-2124
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2823235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist