Healthcare Provider Details

I. General information

NPI: 1346678406
Provider Name (Legal Business Name): SOUTH CAROLINA SPEECH THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2013
Last Update Date: 12/03/2022
Certification Date: 12/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 BELLAGIO WAY
GREER SC
29651-7542
US

IV. Provider business mailing address

6 BELLAGIO WAY
GREER SC
29651-7542
US

V. Phone/Fax

Practice location:
  • Phone: 864-680-2170
  • 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
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JORDAN WINTERS
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: MCD, CCC-SLP
Phone: 864-680-2170