Provider Demographics
NPI:1811511413
Name:GILCHRIST, KENNYATTA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:KENNYATTA
Middle Name:
Last Name:GILCHRIST
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 RHETT CT
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649-2272
Mailing Address - Country:US
Mailing Address - Phone:864-828-0102
Mailing Address - Fax:
Practice Address - Street 1:102 RHETT CT
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649-2272
Practice Address - Country:US
Practice Address - Phone:864-828-0102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-31
Last Update Date:2020-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC000000OtherN/A