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General NPI Number Information
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NPI Number | 1598006215
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Entity Type | Individual
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Provider Name | KELLY WILLIFORD HENNINGS CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 03/05/2013
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 106 E MARTINTOWN RD STE A
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City | NORTH AUGUSTA
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State | SC
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Zip | 29841-3425
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Country | US
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Telephone | 803-993-9959
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Fax | 803-728-3334
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Provider Business Mailing Address
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Address Line | 106 E MARTINTOWN RD STE A
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City | NORTH AUGUSTA
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State | SC
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Zip | 29841-3425
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Country | US
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Telephone | 803-993-9959
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Fax | 803-728-3334
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SLP008111
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 7217
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License Number State | SC
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