Provider Demographics
NPI:1649671900
Name:GARRISON, ELIZABETH SKARDON (MSP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SKARDON
Last Name:GARRISON
Suffix:
Gender:F
Credentials:MSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 708
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29071-0708
Mailing Address - Country:US
Mailing Address - Phone:803-359-3195
Mailing Address - Fax:803-520-8398
Practice Address - Street 1:5175 SUNSET BLVD
Practice Address - Street 2:SUITE M
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7319
Practice Address - Country:US
Practice Address - Phone:803-359-3195
Practice Address - Fax:803-520-8398
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5573235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist