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General NPI Number Information
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NPI Number | 1124528773
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Entity Type | Organization
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Legal Business Name | LOWCOUNTRY SPEECH THERAPY SERVICES & ASSOCIATES, LLC
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Dates
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Enumeration Date | 02/20/2018
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Last Update Date | 04/11/2022
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Provider Practice Location Address
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Address Line | 811 CARN ST
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City | WALTERBORO
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State | SC
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Zip | 29488-4322
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Country | US
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Telephone | 843-879-8810
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Fax | 800-617-8846
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Provider Business Mailing Address
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Address Line | 1312 LIVELY STONE RD
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City | ISLANDTON
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State | SC
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Zip | 29929-3208
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Country | US
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Telephone | 843-879-8810
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPY PROVIDER
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Name | FAITH BRADLEY
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Credential |
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Telephone | 843-879-8810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 4535
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License Number State | SC
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