Provider Demographics
NPI:1821573056
Name:MUDGE, KORI (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KORI
Middle Name:
Last Name:MUDGE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:KORI
Other - Middle Name:
Other - Last Name:MANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1215 CIRCLE RD
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-8221
Mailing Address - Country:US
Mailing Address - Phone:802-683-7702
Mailing Address - Fax:
Practice Address - Street 1:1664 E MAIN ST STE 207
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-3790
Practice Address - Country:US
Practice Address - Phone:864-280-9575
Practice Address - Fax:864-900-0401
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9832733-4102235Z00000X
SC6708235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist