| NPI | 1760763718 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTEN L. DIETRICH Owner, Speech Language Pathologist 843-810-9198 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| 252Y00000X Early Intervention Provider Agency (Licence: SC 4516) | |
| Enumeration Date | 2011-09-05 |
| Last Update Date | 2021-03-22 |