Provider Demographics
NPI:1477904811
Name:CALDWELL, KIERRA ANNE (SLP)
Entity Type:Individual
Prefix:
First Name:KIERRA
Middle Name:ANNE
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6847
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304-6847
Mailing Address - Country:US
Mailing Address - Phone:570-439-4520
Mailing Address - Fax:
Practice Address - Street 1:217 DILLON CIR
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1063
Practice Address - Country:US
Practice Address - Phone:570-439-4520
Practice Address - Fax:570-392-6851
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSLP.6020 SPIN235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist