Provider Demographics
NPI:1003297680
Name:DOUGLAS, KELLI (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:MA 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:PO BOX 411851
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64141-1851
Mailing Address - Country:US
Mailing Address - Phone:913-588-6701
Mailing Address - Fax:913-588-6677
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-8500
Practice Address - Country:US
Practice Address - Phone:913-588-6745
Practice Address - Fax:913-588-4676
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3800235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist