Healthcare Provider Details

I. General information

NPI: 1477537207
Provider Name (Legal Business Name): CAROLINE SPEECH & LANGUAGE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 THAMES AVE
SUMMERVILLE SC
29485-3482
US

IV. Provider business mailing address

PO BOX 51484
SUMMERVILLE SC
29485-1484
US

V. Phone/Fax

Practice location:
  • Phone: 843-832-1795
  • Fax: 843-832-9499
Mailing address:
  • Phone: 843-832-1795
  • Fax: 843-832-9499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number793
License Number StateSC

VIII. Authorized Official

Name: MS. SALLY A ASQUITH
Title or Position: PRESIDENT OWNER
Credential: MS CCC SLP
Phone: 843-832-1795