Provider Demographics
NPI:1730369190
Name:FARLEY, ALICE ANNE GAMBLE (MED, CCC-SLP,BRS-FD)
Entity type:Individual
Prefix:
First Name:ALICE ANNE
Middle Name:GAMBLE
Last Name:FARLEY
Suffix:
Gender:F
Credentials:MED, CCC-SLP,BRS-FD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7434 FOREST CT
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-2825
Mailing Address - Country:US
Mailing Address - Phone:803-252-2538
Mailing Address - Fax:
Practice Address - Street 1:7434 FOREST CT
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2825
Practice Address - Country:US
Practice Address - Phone:803-252-2538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC97235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist