MEDICARE: CARLA LYNN PITTMAN MS, CCC-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	3255	SC

General Provider Information

NPI Number	:	1568110583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLA LYNN PITTMAN MS, CCC-SLP

Provider Business Mailing Address
First Line	:	440 WEST RD
Second Line	:
City	:	ROEBUCK
State	:	SC
Zip	:	29376-3725
Country	:	US
Telephone Number	:	864-205-4408
Fax Number	:

Provider Business Practice Location Address
First Line	:	905 E MAIN ST
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29302-2182
Country	:	US
Telephone Number	:	865-582-5936
Fax Number	:

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

Provider Enumeration Date	:	03/17/2022
Last Update Date	:	03/17/2022

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