Provider Demographics
NPI:1235637091
Name:COX, KELLEY D (SLP)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:D
Last Name:COX
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1999 N AMIDON AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-2122
Mailing Address - Country:US
Mailing Address - Phone:316-768-6718
Mailing Address - Fax:316-202-2356
Practice Address - Street 1:1999 N AMIDON AVE STE 110
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-2122
Practice Address - Country:US
Practice Address - Phone:316-768-6718
Practice Address - Fax:316-202-2356
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-26
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS00661235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty