Provider Demographics
NPI:1659759165
Name:KEMP, MARY KATHERINE (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MARY KATHERINE
Middle Name:
Last Name:KEMP
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 1:180 BURKETTS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:GA
Mailing Address - Zip Code:31539-7132
Mailing Address - Country:US
Mailing Address - Phone:912-539-4232
Mailing Address - Fax:
Practice Address - Street 1:180 BURKETTS FERRY RD
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:GA
Practice Address - Zip Code:31539-7132
Practice Address - Country:US
Practice Address - Phone:912-539-4232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-16
Last Update Date:2015-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008857235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist