Provider Demographics
NPI:1720233166
Name:DORAN, LYNETTE MICHELLE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LYNETTE
Middle Name:MICHELLE
Last Name:DORAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 RIVER RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:SC
Mailing Address - Zip Code:29160-8287
Mailing Address - Country:US
Mailing Address - Phone:843-345-2401
Mailing Address - Fax:800-711-8650
Practice Address - Street 1:259 RIVER RIDGE WAY
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:SC
Practice Address - Zip Code:29160-8287
Practice Address - Country:US
Practice Address - Phone:843-345-2401
Practice Address - Fax:800-711-8650
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-26
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ4684235Z00000X
SC5828235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000-570-800Medicaid
SCSA1788Medicaid