Doctor Name: | CARLOS DION STALEY |
NPI Number: | 1821346990 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.A., CCC-SLP |
License Number: | 3556 |
Business Practice Address: | 4 Foxfield Ln Blythewood, SC - 290169134 |
Business Phone Number: | 8036733985 |
Business Fax Number: | 8035427085 |
Mailing Address: | 4 Foxfield Ln, BLYTHEWOOD |
State: | SC |
Postal Code: | 290169134 |
Phone Number: | 8036733985 |
Fax Number: | 8035427085 |
NPI Enumeration Date: | 08/21/2012 |
NPI Last Update Date: | 08/21/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 3556 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SC |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |