Provider Demographics
NPI:1629000435
Name:KUEBLER, RONALD C (CCC-SLP, ABDA)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:C
Last Name:KUEBLER
Suffix:
Gender:M
Credentials:CCC-SLP, ABDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6601 EASTBROOK RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29206-2207
Mailing Address - Country:US
Mailing Address - Phone:803-429-6730
Mailing Address - Fax:803-787-6889
Practice Address - Street 1:6601 EASTBROOK RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29206-2207
Practice Address - Country:US
Practice Address - Phone:803-429-6730
Practice Address - Fax:803-787-6889
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC816235Z00000X
GA1669235Z00000X
NC6816235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1629000435OtherMEDICARE PART B
SCGP4290Medicaid
SC203658505OtherTRICARE PROVIDER