Provider Demographics
NPI:1295464485
Name:KLOCOW, RYLEE J
Entity Type:Individual
Prefix:MISS
First Name:RYLEE
Middle Name:J
Last Name:KLOCOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 JIMMY DOOLITTLE DR STE B
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-2622
Mailing Address - Country:US
Mailing Address - Phone:864-640-4970
Mailing Address - Fax:864-520-8813
Practice Address - Street 1:10 JIMMY DOOLITTLE DR STE B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2622
Practice Address - Country:US
Practice Address - Phone:864-640-4970
Practice Address - Fax:864-520-8813
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7986235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist