Provider Demographics
NPI:1598006215
Name:HENNINGS, KELLY WILLIFORD (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:WILLIFORD
Last Name:HENNINGS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 E HUGH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-2925
Mailing Address - Country:US
Mailing Address - Phone:803-993-9959
Mailing Address - Fax:803-728-3334
Practice Address - Street 1:105 E HUGH ST
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-2925
Practice Address - Country:US
Practice Address - Phone:803-993-9959
Practice Address - Fax:803-728-3334
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-05
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008111235Z00000X
SC7217235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty