Provider Demographics
NPI:1093089815
Name:PIERCE, KELLI A (SLP)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:A
Last Name:PIERCE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:A
Other - Last Name:MCCUNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2981 KANELL BLVD
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-4008
Mailing Address - Country:US
Mailing Address - Phone:573-712-2280
Mailing Address - Fax:573-778-9589
Practice Address - Street 1:2981 KANELL BLVD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-4008
Practice Address - Country:US
Practice Address - Phone:573-712-2280
Practice Address - Fax:573-778-9589
Is Sole Proprietor?:No
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO110049235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist