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NPI Code Detail

MEDICARE: MR. DAVID ALAN EOUTE JR. MSP, SLP-CFY

MEDICARE: MR. DAVID ALAN EOUTE JR. MSP, SLP-CFY
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
1235Z00000XSpeech-Language Pathologist4191SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11558331264OTHERNPPES

General Provider Information

NPI Number : 1114173994
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DAVID ALAN EOUTE JR. MSP, SLP-CFY
Provider Business Mailing Address
First Line : 1601 SAINT JULIAN PL
Second Line :
City : COLUMBIA
State : SC
Zip : 29204-2407
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1601 SAINT JULIAN PL
Second Line :
City : COLUMBIA
State : SC
Zip : 29204-2407
Country : US
Telephone Number : 803-777-2614
Fax Number : 803-253-4143
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2008
Last Update Date : 08/13/2008

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