Individual
KAYE K. WOOTEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSP, CCC-SLP
Contact information
Practice address
9600 TWO NOTCH RD STE 26, COLUMBIA, SC 29223-1613
(803) 736-5540
Mailing address
707 SUMMIT SQ, COLUMBIA, SC 29229-7164
(803) 736-9727
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2775
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2775
STATE LICENSE NUMBER
SC
Enumeration date
04/02/2007
Last updated
07/08/2007
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