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General NPI Number Information
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NPI Number | 1265665335
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Entity Type | Organization
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Legal Business Name | PEDIATRIC SPEECH THERAPY SERVICES
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Dates
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Enumeration Date | 08/24/2009
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Last Update Date | 08/24/2009
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Provider Practice Location Address
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Address Line | 820 KIPLING DR
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City | COLUMBIA
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State | SC
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Zip | 29205-2036
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Country | US
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Telephone | 803-315-5252
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Fax | 803-787-2973
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Provider Business Mailing Address
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Address Line | 820 KIPLING DR
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City | COLUMBIA
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State | SC
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Zip | 29205-2036
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Country | US
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Telephone | 803-315-5252
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Fax | 803-787-2973
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | MRS. MARYMAC WILLIAMS
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Credential | MA, CCC/SLP
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Telephone | 803-315-5252
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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 | 3360
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License Number State | SC
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