Provider Demographics
NPI:1881763530
Name:WRIGHT, KADRA MCQUEEN (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KADRA
Middle Name:MCQUEEN
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MA, 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:PO BOX 1666
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:SC
Mailing Address - Zip Code:29571-1666
Mailing Address - Country:US
Mailing Address - Phone:180-361-4189
Mailing Address - Fax:843-841-3100
Practice Address - Street 1:609 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:SC
Practice Address - Zip Code:29571-3033
Practice Address - Country:US
Practice Address - Phone:803-614-1898
Practice Address - Fax:843-841-3100
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC72592355S0801X
NC7022235Z00000X
SC4598235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA1256Medicaid