Provider Demographics
NPI:1639653983
Name:MILLS, KENDRA LEA (MA, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:LEA
Last Name:MILLS
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 BLACKBERRY LN
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316-7710
Mailing Address - Country:US
Mailing Address - Phone:864-316-3626
Mailing Address - Fax:
Practice Address - Street 1:316 BLACKBERRY LN
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29316-7710
Practice Address - Country:US
Practice Address - Phone:864-316-3626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-22
Last Update Date:2018-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSLP1127235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist