Provider Demographics
NPI:1649391533
Name:WOOTEN, KAYE K (MSP, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KAYE
Middle Name:K
Last Name:WOOTEN
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 SUMMIT SQ
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7164
Mailing Address - Country:US
Mailing Address - Phone:803-736-9727
Mailing Address - Fax:
Practice Address - Street 1:9600 TWO NOTCH RD STE 26
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-1613
Practice Address - Country:US
Practice Address - Phone:803-736-5540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2775235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2775OtherSTATE LICENSE NUMBER