Healthcare Provider Details

I. General information

NPI: 1346991171
Provider Name (Legal Business Name): PALMETTO KIDS SPEECH THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2022
Last Update Date: 01/13/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 NEWPARK PL
COLUMBIA SC
29212-8667
US

IV. Provider business mailing address

7001 SAINT ANDREWS ROAD STE A12 #261
COLUMBIA SC
29212
US

V. Phone/Fax

Practice location:
  • Phone: 803-386-1880
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JACLYN FLEIG
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: MCD, CCC-SLP
Phone: 803-386-1880