Provider Demographics
NPI:1609991983
Name:VAUGHN, KELLY MCCABE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:MCCABE
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:MCCABE
Other - Last Name:FULMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:2635 RUTHERFORD WAY
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-6677
Mailing Address - Country:US
Mailing Address - Phone:843-693-2109
Mailing Address - Fax:
Practice Address - Street 1:2130 PINEHURST AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-6455
Practice Address - Country:US
Practice Address - Phone:843-763-1538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2021-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3685235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist