Provider Demographics
NPI:1114164845
Name:KELLY, KRISTI LEIGH (MS, CCC, SLP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:LEIGH
Last Name:KELLY
Suffix:
Gender:F
Credentials:MS, CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1136 E STUART ST
Mailing Address - Street 2:STE 3120
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-1196
Mailing Address - Country:US
Mailing Address - Phone:970-682-3743
Mailing Address - Fax:970-460-8708
Practice Address - Street 1:1136 E STUART ST STE 3120
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525
Practice Address - Country:US
Practice Address - Phone:970-682-3743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-16
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0000716235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist