Healthcare Provider Details

I. General information

NPI: 1194434043
Provider Name (Legal Business Name): BIG LITTLE VOICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2022
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4703 OLEANDER DR
MYRTLE BEACH SC
29577-5743
US

IV. Provider business mailing address

4131 WOOD LOOP
ALAMOGORDO NM
88310-5466
US

V. Phone/Fax

Practice location:
  • Phone: 843-254-0722
  • Fax:
Mailing address:
  • Phone: 843-254-0722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. LESLIE A WILFONG
Title or Position: OWNER
Credential: MSP, CCC-SLP
Phone: 843-254-0722