Provider Demographics
NPI:1841717873
Name:MCNEILL, NATASHA ALYSS (MCD CFY-SLP)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:ALYSS
Last Name:MCNEILL
Suffix:
Gender:F
Credentials:MCD CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6013 SWEETBAY LN
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-7837
Mailing Address - Country:US
Mailing Address - Phone:803-236-8759
Mailing Address - Fax:
Practice Address - Street 1:2848 PLEASANT RD STE 101
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-9494
Practice Address - Country:US
Practice Address - Phone:803-236-8759
Practice Address - Fax:803-547-9706
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-30
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5878235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist