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Organization

PEDIATRIC SPEECH THERAPY SERVICES

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. MARYMAC WILLIAMS MA, CCC/SLP (SPEECH-LANGUAGE PATHOLOGIST)
(803) 315-5252
Entity
Organization

Contact information

Practice address
820 KIPLING DR, COLUMBIA, SC 29205-2036
(803) 315-5252
(803) 787-2973
Mailing address
820 KIPLING DR, COLUMBIA, SC 29205-2036
(803) 315-5252
(803) 787-2973

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3360
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
SA0726
SC
Enumeration date
08/24/2009
Last updated
08/24/2009
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