MEDICARE: EDITH H HINES MSP, CCC-SP

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	3596	SC

General Provider Information

NPI Number	:	1629161997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDITH H HINES MSP, CCC-SP

Provider Business Mailing Address
First Line	:	305 HAMPTON TRACE LN
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29209-1916
Country	:	US
Telephone Number	:	803-622-8851
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 HAMPTON TRACE LN
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29209-1916
Country	:	US
Telephone Number	:	803-622-8851
Fax Number	:	803-622-8851

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

Provider Enumeration Date	:	10/01/2006
Last Update Date	:	12/19/2012

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Directions to “ EDITH H HINES MSP, CCC-SP” Practice Location

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