Healthcare Provider Details

I. General information

NPI: 1083707061
Provider Name (Legal Business Name): SALLY D ANDERSON M.S.P., CCC/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

437 E CAMBRIDGE AVE
GREENWOOD SC
29646-2244
US

IV. Provider business mailing address

1818 W ALEXANDER AVE
GREENWOOD SC
29646-9783
US

V. Phone/Fax

Practice location:
  • Phone: 864-223-1950
  • Fax:
Mailing address:
  • Phone: 864-223-2165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number927
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: