Individual
ANDREA LARY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
3803 PALMETTO DR, MYRTLE BEACH, SC 29577-5944
(843) 455-7505
(866) 668-9946
Mailing address
PO BOX 1523, LITTLE RIVER, SC 29566-1523
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
692
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7412289
—
NC
05
—
SA0166
—
SC
Enumeration date
05/03/2006
Last updated
11/14/2012
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