Healthcare Provider Details

I. General information

NPI: 1740247717
Provider Name (Legal Business Name): SALLY A ASQUITH MD CCC SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 OAKBROOK LANE SUITE 335
SUMMERVILLE SC
29485
US

IV. Provider business mailing address

194 THAMES AVE
SUMMERVILLE SC
29485
US

V. Phone/Fax

Practice location:
  • Phone: 843-832-1795
  • Fax: 843-832-9499
Mailing address:
  • Phone: 843-412-6440
  • Fax:

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:
Title or Position:
Credential:
Phone: