Healthcare Provider Details

I. General information

NPI: 1447529532
Provider Name (Legal Business Name): CHATTERBOX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2011
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5358 PEERLESS PLACE DR
WADMALAW ISLAND SC
29487-7119
US

IV. Provider business mailing address

PO BOX 124
WADMALAW ISLAND SC
29487-7119
US

V. Phone/Fax

Practice location:
  • Phone: 843-263-1813
  • Fax:
Mailing address:
  • Phone: 843-263-1813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3984
License Number StateSC

VIII. Authorized Official

Name: STACEY DEVRIES
Title or Position: SPEECH PATHOLOGIST
Credential: CCC-SLP
Phone: 843-263-1813