Provider Demographics
NPI:1396796496
Name:ANDERSON-OCONEE SPEECH & HEARING SERVICES
Entity type:Organization
Organization Name:ANDERSON-OCONEE SPEECH & HEARING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANDON
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:864-226-2477
Mailing Address - Street 1:106 DOSTAK DR
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-6606
Mailing Address - Country:US
Mailing Address - Phone:864-226-2477
Mailing Address - Fax:
Practice Address - Street 1:106 DOSTAK DR
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-6606
Practice Address - Country:US
Practice Address - Phone:864-226-2477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC190188Medicaid
SC426057Medicare ID - Type Unspecified