Healthcare Provider Details

I. General information

NPI: 1437497971
Provider Name (Legal Business Name): WANDA RAYE HUGHES MA , CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2013
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E MARION ST
JOHNSONVILLE SC
29555-6517
US

IV. Provider business mailing address

PO BOX 563
HEMINGWAY SC
29554-0563
US

V. Phone/Fax

Practice location:
  • Phone: 843-386-2955
  • Fax:
Mailing address:
  • Phone: 843-933-2531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3395
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: