Basic Information
Provider Information | |||||||||
NPI: | 1376054908 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CAROLINA SPEECH AND HEARING, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3937 SUNSET BLVD STE B | ||||||||
Address2: |   | ||||||||
City: | WEST COLUMBIA | ||||||||
State: | SC | ||||||||
PostalCode: | 291692423 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8039004890 | ||||||||
FaxNumber: | 8039313891 | ||||||||
Practice Location | |||||||||
Address1: | 3937 SUNSET BLVD STE B | ||||||||
Address2: |   | ||||||||
City: | WEST COLUMBIA | ||||||||
State: | SC | ||||||||
PostalCode: | 29169 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8039004890 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/23/2017 | ||||||||
LastUpdateDate: | 08/28/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | SCHULTZ | ||||||||
AuthorizedOfficialFirstName: | MICHELE | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT/AUDIOLOGIST | ||||||||
AuthorizedOfficialTelephone: | 8039004890 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | AU.D | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 4066 | SC | Y | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist |   |
No ID Information.