Healthcare Provider Details

I. General information

NPI: 1912558826
Provider Name (Legal Business Name): ACCOMPLISH THERAPEUTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2019
Last Update Date: 09/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 OLD VILLAGE DR
MOUNT PLEASANT SC
29464-4941
US

IV. Provider business mailing address

1525 OLD VILLAGE DR
MOUNT PLEASANT SC
29464-4941
US

V. Phone/Fax

Practice location:
  • Phone: 843-532-1325
  • Fax:
Mailing address:
  • Phone: 843-532-1325
  • 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 Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: REBECCA FOSBERRY
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: CCC-SLP
Phone: 843-532-1325