Provider Demographics
NPI:1053562512
Name:SEGRES, WOODRENA CHERISE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:WOODRENA
Middle Name:CHERISE
Last Name:SEGRES
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 SHERWOOD ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556-7541
Mailing Address - Country:US
Mailing Address - Phone:843-382-5373
Mailing Address - Fax:843-382-9246
Practice Address - Street 1:211 SHERWOOD ST
Practice Address - Street 2:
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-7541
Practice Address - Country:US
Practice Address - Phone:843-382-5373
Practice Address - Fax:843-382-9246
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-02
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3627235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1053562512Medicaid