Provider Demographics
NPI:1194540161
Name:RICE, KENDALL (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:
Last Name:RICE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:473 WOODBURY CT SE
Mailing Address - Street 2:
Mailing Address - City:BOLIVIA
Mailing Address - State:NC
Mailing Address - Zip Code:28422-8685
Mailing Address - Country:US
Mailing Address - Phone:910-612-1002
Mailing Address - Fax:910-755-5865
Practice Address - Street 1:20 MEDICAL CAMPUS DR NW STE 204
Practice Address - Street 2:
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462-4094
Practice Address - Country:US
Practice Address - Phone:910-612-1002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-15
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30002605235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist