MEDICARE: KAYE K. WOOTEN MSP, 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	2775	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2775	OTHER	SC	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1649391533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYE K. WOOTEN MSP, CCC-SLP

Provider Business Mailing Address
First Line	:	707 SUMMIT SQ
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-7164
Country	:	US
Telephone Number	:	803-736-9727
Fax Number	:

Provider Business Practice Location Address
First Line	:	9600 TWO NOTCH RD STE 26
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-1613
Country	:	US
Telephone Number	:	803-736-5540
Fax Number	:

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

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	07/08/2007

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Directions to “ KAYE K. WOOTEN MSP, CCC-SLP” Practice Location

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