Provider Demographics
NPI:1831194430
Name:DUNCAN, KERRI POWELL (MSP, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:POWELL
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:KERRI
Other - Middle Name:POWELL
Other - Last Name:MCCORMACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSP, CCC-SLP
Mailing Address - Street 1:1723 GARLAND RD
Mailing Address - Street 2:
Mailing Address - City:GABLE
Mailing Address - State:SC
Mailing Address - Zip Code:29051-9662
Mailing Address - Country:US
Mailing Address - Phone:803-460-3297
Mailing Address - Fax:
Practice Address - Street 1:1723 GARLAND RD
Practice Address - Street 2:
Practice Address - City:GABLE
Practice Address - State:SC
Practice Address - Zip Code:29051-9662
Practice Address - Country:US
Practice Address - Phone:803-460-3297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2233235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA0167Medicaid
NC7411692Medicaid