MEDICARE: KANISHA DENISE MCCREA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	6727	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538726559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KANISHA DENISE MCCREA

Provider Business Mailing Address
First Line	:	PO BOX 403
Second Line	:
City	:	MAULDIN
State	:	SC
Zip	:	29662-0403
Country	:	US
Telephone Number	:	843-230-7966
Fax Number	:

Provider Business Practice Location Address
First Line	:	815 E BUTLER RD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29607-5866
Country	:	US
Telephone Number	:	843-230-7966
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2019
Last Update Date	:	05/17/2022

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Directions to “ KANISHA DENISE MCCREA ” Practice Location

Language	Start Address	Practice Location

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