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General NPI Number Information
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NPI Number | 1508189432
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Entity Type | Organization
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Legal Business Name | NORTHEAST SPEECH-LANGUAGE PATHOLOGY, LLC (NESLP)
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Dates
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Enumeration Date | 03/06/2010
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Last Update Date | 05/20/2010
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Provider Practice Location Address
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Address Line | 576 ANSON DR
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City | COLUMBIA
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State | SC
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Zip | 29229-7422
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Country | US
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Telephone | 803-865-6045
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Fax | 803-865-6045
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Provider Business Mailing Address
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Address Line | P.O. BOX 290302
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City | COLUMBIA
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State | SC
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Zip | 29229
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Country | US
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Telephone | 803-260-6471
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Fax | 803-865-6045
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | MRS. LASHAWN C THOMAS BRIDGES
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Credential | MA CCC/SLP
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Telephone | 803-429-2327
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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 | 2673
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License Number State | SC
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