Provider Demographics
NPI:1770121949
Name:RAWL, KELLY DAVIS (MSP, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:DAVIS
Last Name:RAWL
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:AMANDA
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 TARRAR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-3835
Mailing Address - Country:US
Mailing Address - Phone:803-821-1000
Mailing Address - Fax:803-821-1010
Practice Address - Street 1:100 TARRAR SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-3835
Practice Address - Country:US
Practice Address - Phone:803-821-1000
Practice Address - Fax:803-821-1010
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist