Provider Demographics
NPI:1073939260
Name:TRAVIS, KELLI ANN
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:ANN
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KELLI
Other - Middle Name:ANN
Other - Last Name:ROLLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:701 S MAIN ST (BROKEN ARROW PUBLIC SCHOOLS-SPECIAL SERV
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012
Mailing Address - Country:US
Mailing Address - Phone:918-259-5700
Mailing Address - Fax:918-455-2588
Practice Address - Street 1:701 S MAIN ST (BROKEN ARROW PUBLIC SCHOOLS-SPECIAL SERV
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012
Practice Address - Country:US
Practice Address - Phone:918-259-5700
Practice Address - Fax:918-455-2588
Is Sole Proprietor?:No
Enumeration Date:2014-03-12
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1592235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist