MEDICARE: EMMIE CULCLASURE VAN LAAN MSP, 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	7425	SC
2	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1629545355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMIE CULCLASURE VAN LAAN MSP, CCC-SLP

Provider Business Mailing Address
First Line	:	142 SPORTSMAN ISLAND DR STE E
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29492-8524
Country	:	US
Telephone Number	:	478-954-6167
Fax Number	:

Provider Business Practice Location Address
First Line	:	142 SPORTSMAN ISLAND DR STE E
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29492-8524
Country	:	US
Telephone Number	:	478-954-6167
Fax Number	:

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

Provider Enumeration Date	:	10/31/2018
Last Update Date	:	02/28/2025

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Directions to “ EMMIE CULCLASURE VAN LAAN MSP, CCC-SLP” Practice Location

Language	Start Address	Practice Location

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