Doctor Name: | KELLEY KINARD MALLARD |
NPI Number: | 1013255801 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSP, CCC-SLP |
License Number: | 4204 |
Business Practice Address: | 222 Red Bank Rd Goose Creek, SC - 294454502 |
Business Phone Number: | 8436282935 |
Business Fax Number: | |
Mailing Address: | 1713 Boone Hall Dr Apt I1, CHARLESTON |
State: | SC |
Postal Code: | 294073027 |
Phone Number: | 4044415601 |
Fax Number: | |
NPI Enumeration Date: | 01/29/2013 |
NPI Last Update Date: | 01/29/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 4204 |
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 |