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General NPI Number Information
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NPI Number | 1518485861
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Entity Type | Individual
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Provider Name | TESS JOELL HALVERSON
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Gender | Female
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Dates
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Enumeration Date | 09/07/2017
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | 4550 MIXSON AVE APT 12224
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City | NORTH CHARLESTON
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State | SC
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Zip | 29405-5318
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Country | US
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Telephone | 304-376-2908
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Fax | 888-965-4405
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Provider Business Mailing Address
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Address Line | 650 ENTERPRISE BLVD APT 10202
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City | CHARLESTON
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State | SC
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Zip | 29492-8555
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Country | US
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Telephone | 843-569-4546
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Fax | 843-569-4535
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 6365
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License Number State | SC
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