Organization
SIMPSONVILLE SPEECH THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTEN STAPLES JACKSON CCC-SLP (OWNER)
(864) 757-2553
Entity
Organization
Contact information
Practice address
202 BEAUCLAIR DR, SIMPSONVILLE, SC 29680-6902
(864) 757-2553
Mailing address
202 BEAUCLAIR DR, SIMPSONVILLE, SC 29680-6902
(864) 757-2553
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SA1961
—
SC
Enumeration date
09/29/2020
Last updated
09/29/2020
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