Provider Demographics
NPI:1043454671
Name:CROUCHER, KELLI CHRISTENE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:CHRISTENE
Last Name:CROUCHER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MRS
Other - First Name:KELLI
Other - Middle Name:CHRISTENE
Other - Last Name:CROUCHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:5616 CORNELL DR
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-8821
Mailing Address - Country:US
Mailing Address - Phone:918-440-0030
Mailing Address - Fax:
Practice Address - Street 1:5616 CORNELL DR
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-8821
Practice Address - Country:US
Practice Address - Phone:918-440-0030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3215235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist