Individual
MR. JACK GORDON SCHULTZ JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S.P
Contact information
Practice address
1006 INDIGO AVE, CAYCE, SC 29033-3210
(803) 586-5280
Mailing address
1006 INDIGO AVE, CAYCE, SC 29033-3210
(803) 586-5280
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
4182
SC
Other
Enumeration date
03/31/2008
Last updated
03/31/2008
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