Provider Demographics
NPI:1104013150
Name:BAUER, KELLIE L (MED)
Entity Type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:L
Last Name:BAUER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:593 ADERHOLD HALL
Mailing Address - Street 2:UNIVERSITY OF GEORGIA SPEECH AND HEARING CLINIC
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30602
Mailing Address - Country:US
Mailing Address - Phone:706-542-6157
Mailing Address - Fax:
Practice Address - Street 1:593 ADERHOLD HALL
Practice Address - Street 2:UNIVERSITY OF GEORGIA SPEECH AND HEARING CLINIC
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30602
Practice Address - Country:US
Practice Address - Phone:706-542-4598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006674235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist