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1336264225
KRISTY PROVEAUX
WEST COLUMBIA, SC
NPI
1336264225
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
235Z00000X Speech-Language Pathologist,
(Licence: SC 3463)
Enumeration Date
2007-03-20
Last Update Date
2016-06-15
Business Address
-- KRISTY PROVEAUX m.s. ccc-slp
3681 LEAPHART RD STE A
WEST COLUMBIA, SC 29169-3068
Phone number: 803-600-6519
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Mailing Address
-- KRISTY PROVEAUX m.s. ccc-slp
4129 COLUMBIA RD
ORANGEBURG, SC 29118-1264
Phone number: 803-600-6519
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