Provider Demographics
NPI:1164839296
Name:UPSTATE SPEECH AND LANGUAGE SERVICES, LLC
Entity type:Organization
Organization Name:UPSTATE SPEECH AND LANGUAGE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MERRI
Authorized Official - Middle Name:ALLISON
Authorized Official - Last Name:MUGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MCD, CCC-SLP
Authorized Official - Phone:864-633-5647
Mailing Address - Street 1:952 BREEZEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-6908
Mailing Address - Country:US
Mailing Address - Phone:864-633-5647
Mailing Address - Fax:864-633-5643
Practice Address - Street 1:952 BREEZEWOOD CT
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-6908
Practice Address - Country:US
Practice Address - Phone:864-633-5647
Practice Address - Fax:864-633-5643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5382235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA1425Medicaid