Healthcare Provider Details

I. General information

NPI: 1124576905
Provider Name (Legal Business Name): KELSEY LOVINE SKORZEWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2016
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 HICKORY MEADOW RD
LEXINGTON SC
29072-8876
US

IV. Provider business mailing address

141 HICKORY MEADOW RD
LEXINGTON SC
29072-8876
US

V. Phone/Fax

Practice location:
  • Phone: 803-391-2603
  • Fax:
Mailing address:
  • Phone: 803-391-2603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number6070
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: