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General NPI Number Information
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NPI Number | 1912234204
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Entity Type | Organization
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Legal Business Name | TEAM THERAPY SC, LLC
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Dates
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Enumeration Date | 11/08/2009
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Last Update Date | 11/08/2009
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Provider Practice Location Address
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Address Line | 5 BLACK GUM RD
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City | COLUMBIA
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State | SC
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Zip | 29209-1901
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Country | US
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Telephone | 803-240-5026
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Fax |
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Provider Business Mailing Address
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Address Line | 5 BLACK GUM RD
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City | COLUMBIA
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State | SC
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Zip | 29209-1901
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Country | US
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Telephone | 803-240-5026
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. LESLIE MCGILL MCKENZIE
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Credential | MSP, CCC-SLP
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Telephone | 803-240-5026
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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 | 3704
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License Number State | SC
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