Provider Demographics
NPI:1649457573
Name:WADFORD, SALLIE P (MCD)
Entity type:Individual
Prefix:
First Name:SALLIE
Middle Name:P
Last Name:WADFORD
Suffix:
Gender:F
Credentials:MCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:ANDREWS
Mailing Address - State:SC
Mailing Address - Zip Code:29510-5144
Mailing Address - Country:US
Mailing Address - Phone:843-221-7433
Mailing Address - Fax:
Practice Address - Street 1:802 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:ANDREWS
Practice Address - State:SC
Practice Address - Zip Code:29510-5144
Practice Address - Country:US
Practice Address - Phone:843-221-7433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3620235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist