Healthcare Provider Details

I. General information

NPI: 1770405375
Provider Name (Legal Business Name): MARY HUTH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11944 BROAD RIVER RD
CHAPIN SC
29036-8905
US

IV. Provider business mailing address

PO BOX 281
BALLENTINE SC
29002-0281
US

V. Phone/Fax

Practice location:
  • Phone: 803-530-3555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number9370
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: