MEDICARE: BETHANY SANDIFER CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	8819	SC
2	235Z00000X	Speech-Language Pathologist	SLP013718	GA

General Provider Information

NPI Number	:	1063394872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY SANDIFER CCC-SLP

Provider Business Mailing Address
First Line	:	802 E MARTINTOWN RD STE 403
Second Line	:
City	:	NORTH AUGUSTA
State	:	SC
Zip	:	29841-5328
Country	:	US
Telephone Number	:	803-216-1522
Fax Number	:	833-799-3525

Provider Business Practice Location Address
First Line	:	802 E MARTINTOWN RD STE 403
Second Line	:
City	:	NORTH AUGUSTA
State	:	SC
Zip	:	29841-5328
Country	:	US
Telephone Number	:	803-216-1522
Fax Number	:	833-799-3525

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2025
Last Update Date	:	03/25/2026

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Directions to “ BETHANY SANDIFER CCC-SLP” Practice Location

Language	Start Address	Practice Location

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