Provider Demographics
NPI:1780068619
Name:COMPLETE SPEECH & WELLNESS, LLC
Entity type:Organization
Organization Name:COMPLETE SPEECH & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LAKEETA
Authorized Official - Middle Name:
Authorized Official - Last Name:LADSON-ABROM
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC/SLP
Authorized Official - Phone:704-517-5841
Mailing Address - Street 1:445 RAST ST
Mailing Address - Street 2:SUITE L
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-2579
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3870 RHODODENDRON ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29154-1691
Practice Address - Country:US
Practice Address - Phone:704-517-5841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPLETE SPEECH THERAPY & WELLNESS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-09
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9366235Z00000X
SC3488235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1306269709Medicaid
SCNPB689Medicaid