Provider Demographics
NPI:1558503045
Name:STANFORD, KERRI (MSP CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KERRI
Middle Name:
Last Name:STANFORD
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 1:27 WESTSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-1967
Mailing Address - Country:US
Mailing Address - Phone:803-419-2226
Mailing Address - Fax:
Practice Address - Street 1:109 VISTA OAKS DR
Practice Address - Street 2:SUITE A
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-8230
Practice Address - Country:US
Practice Address - Phone:803-356-9833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4322235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist