Provider Demographics
NPI:1649479353
Name:SCHAEDIG, THERESA JANE (MA,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:JANE
Last Name:SCHAEDIG
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6010 LANAI LN
Mailing Address - Street 2:
Mailing Address - City:TEGA CAY
Mailing Address - State:SC
Mailing Address - Zip Code:29708-9320
Mailing Address - Country:US
Mailing Address - Phone:803-370-9547
Mailing Address - Fax:
Practice Address - Street 1:6010 LANAI LN
Practice Address - Street 2:
Practice Address - City:TEGA CAY
Practice Address - State:SC
Practice Address - Zip Code:29708-9320
Practice Address - Country:US
Practice Address - Phone:803-370-9547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4158235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4158OtherSOUTH CAROLINA STATE LICE