Kelley Kinard Mallard, MSP, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

4204 Issued in SC

Practice address

222 Red Bank Rd
Goose Creek, SC 29445-4502

Phone

(843) 628-2935

NPI assigned

Jan 29, 2013

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1359417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707350400000",
    "number": "1013255801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1574 CARTERETT AVE",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294074218",
            "telephone_number": "404-441-5601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 RED BANK RD",
            "city": "GOOSE CREEK",
            "state": "SC",
            "postal_code": "294454502",
            "telephone_number": "843-628-2935"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1574 Carterett Ave",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "SC",
            "postal_code": "294074218",
            "country_code": "US",
            "telephone_number": "404-441-5601",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MALLARD",
        "first_name": "KELLEY",
        "middle_name": "KINARD",
        "credential": "MSP, CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-01-29",
        "last_updated": "2024-02-08",
        "certification_date": "2024-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "SC",
            "license": "4204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timothy Macon, SFIDC
• Katherine Marie Maher, PT, DPT
• Michael Majetic, ADV
• Rachel Maki
• Valerie Malizzia, DPT
• Brianna Marie Mamrega, PHARMD
• Lloyd Bernard Mandel, M.D.
• Elise Michele Marchetti
• Ma Angelica David Mariano, PHARM D
• Marshall V Miller

• Speech-Language Pathologist in Goose Creek, SC
• Providers in Goose Creek, SC by specialty
• Speech-Language Pathologist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.