Provider Demographics
NPI:1679203061
Name:KUYKENDALL, KARI GRACE SMITH (MCD CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:GRACE SMITH
Last Name:KUYKENDALL
Suffix:
Gender:F
Credentials:MCD CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 WILLOW BEACH RD
Mailing Address - Street 2:
Mailing Address - City:ELLERSLIE
Mailing Address - State:GA
Mailing Address - Zip Code:31807-5920
Mailing Address - Country:US
Mailing Address - Phone:706-329-6788
Mailing Address - Fax:
Practice Address - Street 1:117 WILLOW BEACH RD
Practice Address - Street 2:
Practice Address - City:ELLERSLIE
Practice Address - State:GA
Practice Address - Zip Code:31807-5920
Practice Address - Country:US
Practice Address - Phone:706-329-6788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008520235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist