Provider Demographics
NPI:1679537963
Name:SMITH, ELEANOR G (CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:ELEANOR
Middle Name:G
Last Name:SMITH
Suffix:
Gender:F
Credentials:CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 BEN SAWYER BLVD
Mailing Address - Street 2:UNIT 1-E
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-5501
Mailing Address - Country:US
Mailing Address - Phone:843-856-4949
Mailing Address - Fax:843-884-9082
Practice Address - Street 1:1551 BEN SAWYER BLVD
Practice Address - Street 2:UNIT 1-E
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-5501
Practice Address - Country:US
Practice Address - Phone:843-856-4949
Practice Address - Fax:843-884-9082
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC312235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3442Medicaid