Provider Demographics
NPI:1548307382
Name:GRAINGER SPEECH LANGUAGE PATHOLOGY SERVICES INC
Entity type:Organization
Organization Name:GRAINGER SPEECH LANGUAGE PATHOLOGY SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC SLP
Authorized Official - Phone:843-774-7462
Mailing Address - Street 1:1928 GADDYS MILL RD
Mailing Address - Street 2:
Mailing Address - City:HAMER
Mailing Address - State:SC
Mailing Address - Zip Code:29547-7033
Mailing Address - Country:US
Mailing Address - Phone:843-774-7462
Mailing Address - Fax:
Practice Address - Street 1:126 N MACARTHUR AVE
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536-3434
Practice Address - Country:US
Practice Address - Phone:843-774-7462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3847235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4274Medicaid