Provider Demographics
NPI:1093003097
Name:YANCEY, KELLY SAMMIS (AUD/CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:SAMMIS
Last Name:YANCEY
Suffix:
Gender:F
Credentials:AUD/CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11307 FM 1960 RD W
Mailing Address - Street 2:STE 260
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-3687
Mailing Address - Country:US
Mailing Address - Phone:832-604-3636
Mailing Address - Fax:919-439-3048
Practice Address - Street 1:11307 FM 1960 RD W
Practice Address - Street 2:STE 260
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-3687
Practice Address - Country:US
Practice Address - Phone:832-604-3636
Practice Address - Fax:919-439-3048
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80343231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80343OtherAUDIOLOGY LICENSE