Provider Demographics
NPI:1336389956
Name:KENNETTE, CORRIE LEIGH (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:CORRIE
Middle Name:LEIGH
Last Name:KENNETTE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 FISHER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29365-9244
Mailing Address - Country:US
Mailing Address - Phone:864-439-1436
Mailing Address - Fax:
Practice Address - Street 1:441 LANCASTER FARM RD
Practice Address - Street 2:
Practice Address - City:ROEBUCK
Practice Address - State:SC
Practice Address - Zip Code:29376-3727
Practice Address - Country:US
Practice Address - Phone:864-205-1410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-22
Last Update Date:2009-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4167235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist