Healthcare Provider Details

I. General information

NPI: 1245547413
Provider Name (Legal Business Name): ASHLEY PATE HUDSON MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 07/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 STALLSVILLE RD
SUMMERVILLE SC
29485-4934
US

IV. Provider business mailing address

1418 WHISPERING OAKS TRL
MT PLEASANT SC
29466-8584
US

V. Phone/Fax

Practice location:
  • Phone: 843-832-1795
  • Fax:
Mailing address:
  • Phone: 704-689-6441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP.4744SLP
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: