Provider Demographics
NPI:1952693723
Name:UPSTATE PEDIATRIC SPEECH THERAPY SERVICES
Entity Type:Organization
Organization Name:UPSTATE PEDIATRIC SPEECH THERAPY SERVICES
Other - Org Name:UPSTATE PEDIATRIC SPEECH THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SLP/PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:864-438-0990
Mailing Address - Street 1:310 NEW NEELY FERRY RD
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-2617
Mailing Address - Country:US
Mailing Address - Phone:864-438-0990
Mailing Address - Fax:864-478-8383
Practice Address - Street 1:310 NEW NEELY FERRY RD
Practice Address - Street 2:
Practice Address - City:MAULDIN
Practice Address - State:SC
Practice Address - Zip Code:29662-2617
Practice Address - Country:US
Practice Address - Phone:864-438-0990
Practice Address - Fax:864-478-8383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-11
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty