Provider Demographics
NPI:1619220225
Name:CHARLESTON SPEECH & LANGUAGE SERVICES, LLC
Entity type:Organization
Organization Name:CHARLESTON SPEECH & LANGUAGE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUCRETIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESPIRITU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-509-7897
Mailing Address - Street 1:115 OLD JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-8800
Mailing Address - Country:US
Mailing Address - Phone:843-509-7897
Mailing Address - Fax:843-797-3117
Practice Address - Street 1:115 OLD JACKSON ROAD
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-8800
Practice Address - Country:US
Practice Address - Phone:843-509-7897
Practice Address - Fax:843-797-3117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3883235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty