Provider Demographics
NPI:1326103714
Name:MYERS, KELLIE ROSE
Entity Type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:ROSE
Last Name:MYERS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KELLIE
Other - Middle Name:ROSE
Other - Last Name:HOHMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1254 CHALLENGE RD
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-4548
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1254 CHALLENGE RD
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-4548
Practice Address - Country:US
Practice Address - Phone:630-621-2882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146008731235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist