Kimberly Robertson Scanlon, MA, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

6936 Issued in SC

Practice address

284 Blanton LN
Cottageville, SC 29435-3108

Phone

(843) 909-0748

NPI assigned

Oct 14, 2017

Sex

Female

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

• Kimberly Lynn Robertson Former name

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 22, 2021.

{
    "created_epoch": "1507939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611273600000",
    "number": "1871004085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "284 BLANTON LN",
            "city": "COTTAGEVILLE",
            "state": "SC",
            "postal_code": "294353108",
            "telephone_number": "843-909-0748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "284 BLANTON LN",
            "city": "COTTAGEVILLE",
            "state": "SC",
            "postal_code": "294353108",
            "telephone_number": "843-909-0748"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "58 Eastham St",
            "address_purpose": "LOCATION",
            "city": "Vanceburg",
            "state": "KY",
            "postal_code": "411795462",
            "country_code": "US",
            "telephone_number": "606-796-3046",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SCANLON",
        "first_name": "KIMBERLY",
        "middle_name": "ROBERTSON",
        "credential": "MA, CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-14",
        "last_updated": "2021-01-22",
        "certification_date": "2021-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "KY",
            "license": "168249",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "SC",
            "license": "6936",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "ROBERTSON",
            "middle_name": "LYNN",
            "credential": "MA, CCC-SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Deanna L Borek, COTA/L
• Deneya Dingle, RN,BSN
• Emily Carpen Golubow
• Victoria Hall
• Juanett Maxwell
• Krystal Seipp

• All providers in Cottageville, SC
• Speech-Language Pathologist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2021; 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.