MEDICARE: SASSAFRAS SPEECH THERAPY, 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

General Provider Information

NPI Number	:	1679435242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SASSAFRAS SPEECH THERAPY, LLC

Provider Business Mailing Address
First Line	:	101 LIVE OAK AVE
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-2702
Country	:	US
Telephone Number	:	217-493-6154
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 LIVE OAK AVE
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-2702
Country	:	US
Telephone Number	:	217-493-6154
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. HALEY EIFERT
Credential	:	CCC-SLP
Telephone Number	:	217-493-6154

Provider Enumeration Date	:	12/02/2025
Last Update Date	:	12/02/2025

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