Provider Demographics
NPI:1497001853
Name:SELENT, KIM H (MED, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:KIM
Middle Name:H
Last Name:SELENT
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 LOUISVILLE DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-6527
Mailing Address - Country:US
Mailing Address - Phone:770-843-7364
Mailing Address - Fax:
Practice Address - Street 1:48 CLUB FOREST LN
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-3152
Practice Address - Country:US
Practice Address - Phone:864-370-0131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4170235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist