Individual
MRS. TABITHA BERRY PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, CCC-SLP
Contact information
Practice address
203 N MAPLE STREET, SUITE 10, SIMPSONVILLE, SC 29681-2449
(864) 757-9846
(864) 757-9847
Mailing address
203 N MAPLE STREET, SUITE 10, SIMPSONVILLE, SC 29681-2449
(864) 757-9846
(864) 757-9847
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2204
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SA0445
—
SC
Enumeration date
05/02/2007
Last updated
06/19/2012
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