MEDICARE: KRISTY PROVEAUX M.S. CCC-SLP

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	3463	SC

General Provider Information

NPI Number	:	1336264225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTY PROVEAUX M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	4129 COLUMBIA RD
Second Line	:
City	:	ORANGEBURG
State	:	SC
Zip	:	29118-1264
Country	:	US
Telephone Number	:	803-600-6519
Fax Number	:

Provider Business Practice Location Address
First Line	:	3681 LEAPHART RD STE A
Second Line	:
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29169-3068
Country	:	US
Telephone Number	:	803-600-6519
Fax Number	:

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	06/15/2016

Similar Medicare Providers

1497832083 — DR. LYSA CHARLES MD
Practice Location Address:

2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNT 6 WEST , KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
ROCKVILLE, MD
20852-4908

Practice Phone: 301-816-6660
Practice Fax: 301-816-6308

1225000482 — DR. DAVID CHANDLER DC
Practice Location Address:

3681 LEAPHART RD , STE D
WEST COLUMBIA, SC
29169-3068

Practice Phone: 803-796-0855
Practice Fax: 803-796-0028

1467506022 — SHAY F WEED OTR/L
Practice Location Address:

3681 LEAPHART RD STE A
WEST COLUMBIA, SC
29169-3068

Practice Phone: 803-454-6090
Practice Fax: 803-454-6090

1376904177 — JESSICA BAKER PTA
Practice Location Address:

3681 LEAPHART RD STE A
WEST COLUMBIA, SC
29169-3068

Practice Phone: 803-454-6090
Practice Fax: 803-454-6090

1255792909 — BARRY DUNCAN PTA
Practice Location Address:

3681 LEAPHART RD STE A
WEST COLUMBIA, SC
29169-3068

Practice Phone: 803-454-6090
Practice Fax:

1154782811 — MARY THELMA STEWART PTA
Practice Location Address:

3681 LEAPHART RD STE A
WEST COLUMBIA, SC
29169-3068

Practice Phone: 803-454-6090
Practice Fax:

Directions to “ KRISTY PROVEAUX M.S. CCC-SLP” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.