Provider Demographics
NPI:1457962151
Name:CLANTON, ROSALYN MCFADDEN
Entity Type:Individual
Prefix:
First Name:ROSALYN
Middle Name:MCFADDEN
Last Name:CLANTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 WYANDOT ST
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29532-4210
Mailing Address - Country:US
Mailing Address - Phone:843-269-1780
Mailing Address - Fax:
Practice Address - Street 1:105 ROBERTS FARM RD
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-7241
Practice Address - Country:US
Practice Address - Phone:803-447-8877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty