Provider Demographics
NPI:1811229800
Name:MCKINNEY, KELLIN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KELLIN
Middle Name:
Last Name:MCKINNEY
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:PO BOX 5715
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29250-5715
Mailing Address - Country:US
Mailing Address - Phone:803-256-0735
Mailing Address - Fax:803-356-6902
Practice Address - Street 1:3020 FARROW RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-7002
Practice Address - Country:US
Practice Address - Phone:803-256-0735
Practice Address - Fax:803-356-6902
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4608235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist