Provider Demographics
NPI:1689808768
Name:SIMMONS, KRISTIN E (SLP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:E
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 WHITE KNOLL WAY
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29170-3419
Mailing Address - Country:US
Mailing Address - Phone:803-821-4552
Mailing Address - Fax:
Practice Address - Street 1:132 WHITE KNOLL WAY
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29170-3419
Practice Address - Country:US
Practice Address - Phone:803-821-4552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4808235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist