MEDICARE: MARY ELIZABETH DUNLAP SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	4621	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12004296	OTHER		CAQH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497982474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ELIZABETH DUNLAP SLP

Provider Business Mailing Address
First Line	:	1127 QUEENSBOROUGH BLVD STE 104
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-5431
Country	:	US
Telephone Number	:	843-216-0290
Fax Number	:

Provider Business Practice Location Address
First Line	:	1127 QUEENSBOROUGH BLVD STE 104
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-5431
Country	:	US
Telephone Number	:	843-216-0290
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2009
Last Update Date	:	06/07/2023

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