Healthcare Provider Details

I. General information

NPI: 1952232969
Provider Name (Legal Business Name): SKYLAR SANDERS MCINTOSH CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 ALICE DR
SUMTER SC
29150-1905
US

IV. Provider business mailing address

333 REYNOLDS RD
PINEWOOD SC
29125-9550
US

V. Phone/Fax

Practice location:
  • Phone: 843-742-0147
  • Fax:
Mailing address:
  • Phone: 843-742-0147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14482425
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: