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NPI Code Detail

MEDICARE: RAVEN PEARCE FAIR CCC SLP

MEDICARE: RAVEN PEARCE FAIR 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
1235Z00000XSpeech-Language Pathologist5646SC

General Provider Information

NPI Number : 1851899025
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAVEN PEARCE FAIR CCC SLP
Provider Business Mailing Address
First Line : 181 TOWN CREEK RD
Second Line :
City : AIKEN
State : SC
Zip : 29803-5841
Country : US
Telephone Number : 803-642-0700
Fax Number : 803-642-0588
Provider Business Practice Location Address
First Line : 714 S LAKE DR STE 150
Second Line :
City : LEXINGTON
State : SC
Zip : 29072-3473
Country : US
Telephone Number : 803-356-4782
Fax Number : 803-996-4782
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2018
Last Update Date : 07/22/2021

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Directions to “ RAVEN PEARCE FAIR CCC SLP” Practice Location

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