Individual
SAMANTHA JO DESTAZIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
290 N GROVE MEDICAL PARK DR, SPARTANBURG, SC 29303-4222
(864) 345-1700
Mailing address
290 N GROVE MEDICAL PARK DR, SPARTANBURG, SC 29303-4222
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
6550
SC
Other
Enumeration date
04/11/2019
Last updated
04/11/2019
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