Provider Demographics
NPI:1518538024
Name:JURICH, KYLEE RAE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KYLEE
Middle Name:RAE
Last Name:JURICH
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 1:108 BELFAIR RD
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-8040
Mailing Address - Country:US
Mailing Address - Phone:954-263-6526
Mailing Address - Fax:
Practice Address - Street 1:108 BELFAIR RD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-8040
Practice Address - Country:US
Practice Address - Phone:803-629-1981
Practice Address - Fax:803-825-4830
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7665235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist