Provider Demographics
NPI:1225300064
Name:KLECKLEY, SHARON DENISE (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:DENISE
Last Name:KLECKLEY
Suffix:
Gender:F
Credentials: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:CMR 467 UNIT DODDS
Mailing Address - Street 2:PO BOX 276
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09096
Mailing Address - Country:US
Mailing Address - Phone:611-360-5166
Mailing Address - Fax:
Practice Address - Street 1:7950 MARTIN LOOP
Practice Address - Street 2:
Practice Address - City:FT. BENNING
Practice Address - State:GA
Practice Address - Zip Code:31905
Practice Address - Country:US
Practice Address - Phone:706-544-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA01944235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist