Basic Information
| Provider Information | |||||||||
| NPI: | 1932319688 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLEMONS | ||||||||
| FirstName: | SHONDRE | ||||||||
| MiddleName: | COSTINE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MA,CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 536 OLD HOWELL RD | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296151969 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8775083237 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 536 OLD HOWELL RD | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296151969 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8775083237 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2007 | ||||||||
| LastUpdateDate: | 08/11/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 1784 | AL | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | SLP006951 | GA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.