Healthcare Provider Details

I. General information

NPI: 1538143417
Provider Name (Legal Business Name): DONNA G. HUTCHINSON MSP CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DONNA G. LONG MSP CCC-SLP

II. Dates (important events)

Enumeration Date: 12/03/2005
Last Update Date: 04/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 RIGLAW CIR
LEXINGTON SC
29073-7192
US

IV. Provider business mailing address

PO BOX 118
GILBERT SC
29054-0118
US

V. Phone/Fax

Practice location:
  • Phone: 803-429-7463
  • Fax: 803-520-8623
Mailing address:
  • Phone: 803-429-7463
  • Fax: 803-520-8623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3350
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: