Provider Demographics
NPI:1750430369
Name:HAFNER, LAUREL ELIZABETH (MSP)
Entity type:Individual
Prefix:MRS
First Name:LAUREL
Middle Name:ELIZABETH
Last Name:HAFNER
Suffix:
Gender:F
Credentials:MSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 PARISH WALK
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:SC
Mailing Address - Zip Code:29045-1039
Mailing Address - Country:US
Mailing Address - Phone:803-865-7499
Mailing Address - Fax:
Practice Address - Street 1:203 PARISH WALK
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:SC
Practice Address - Zip Code:29045-1039
Practice Address - Country:US
Practice Address - Phone:803-865-7499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3087235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA0354Medicaid