Healthcare Provider Details

I. General information

NPI: 1346170198
Provider Name (Legal Business Name): LYDIA CAMPBELL BREEDLOVE CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 COMMERCIAL CENTER DR
LADSON SC
29456-4146
US

IV. Provider business mailing address

3851 COMMERCIAL CENTER DR
LADSON SC
29456-4146
US

V. Phone/Fax

Practice location:
  • Phone: 888-510-6369
  • Fax: 843-277-6237
Mailing address:
  • Phone: 888-510-6369
  • Fax: 843-277-6237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number9268
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: