MEDICARE: CAROLINA CHAT & CHEW LLC

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	3596	SC

General Provider Information

NPI Number	:	1548506421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA CHAT & CHEW LLC

Provider Business Mailing Address
First Line	:	305 HAMPTON TRACE LN
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29209-1916
Country	:	US
Telephone Number	:	803-622-8851
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 HAMPTON TRACE LN
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29209-1916
Country	:	US
Telephone Number	:	803-622-8851
Fax Number	:

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLOGIST
Name	:	MS. EDITH HOLLER HINES
Credential	:	MSP/CCC-SLP
Telephone Number	:	803-622-8851

Provider Enumeration Date	:	12/20/2012
Last Update Date	:	12/20/2012

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Directions to “CAROLINA CHAT & CHEW LLC ” Practice Location

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