Provider Demographics
NPI:1265985436
Name:DURKIN, ALICIA MARIE (AUD)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:MARIE
Last Name:DURKIN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 ONYX RDG STE 102
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8991
Mailing Address - Country:US
Mailing Address - Phone:803-547-5700
Mailing Address - Fax:
Practice Address - Street 1:1515 ONYX RDG STE 102
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8991
Practice Address - Country:US
Practice Address - Phone:038-547-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12042231H00000X
SC4059231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ54157AOtherMEDICARE
SCSAN136Medicaid
SCSAN136Medicaid