Provider Demographics
NPI:1710121546
Name:AMMONS, KERRIE ALLEN (MCD, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KERRIE
Middle Name:ALLEN
Last Name:AMMONS
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 1:1931 BULL ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2560
Mailing Address - Country:US
Mailing Address - Phone:803-767-4832
Mailing Address - Fax:
Practice Address - Street 1:103 CLAIR DR STE A
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:SC
Practice Address - Zip Code:29673-6401
Practice Address - Country:US
Practice Address - Phone:864-295-0944
Practice Address - Fax:864-751-1646
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC253Z00000X235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist