Organization
TEAM THERAPY SC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LESLIE MCGILL MCKENZIE MSP, CCC-SLP (PRESIDENT)
(803) 240-5026
Entity
Organization
Contact information
Practice address
5 BLACK GUM RD, COLUMBIA, SC 29209-1901
(803) 240-5026
Mailing address
5 BLACK GUM RD, COLUMBIA, SC 29209-1901
(803) 240-5026
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3704
SC
Other
Enumeration date
11/08/2009
Last updated
11/08/2009
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