Provider Demographics
NPI:1043566912
Name:COLUMBUS, KELLY SHERWOOD (MSP, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:SHERWOOD
Last Name:COLUMBUS
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:638 LONGS POND RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-9387
Mailing Address - Country:US
Mailing Address - Phone:803-821-5522
Mailing Address - Fax:
Practice Address - Street 1:638 LONGS POND RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073-9387
Practice Address - Country:US
Practice Address - Phone:803-821-5522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-30
Last Update Date:2019-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5088235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist