Provider Demographics
NPI:1326418864
Name:WARREN, KELLEY (SLP-CCC)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:WARREN
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 SPILLERS LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-2415
Mailing Address - Country:US
Mailing Address - Phone:713-336-3419
Mailing Address - Fax:
Practice Address - Street 1:27902 MOUND RD
Practice Address - Street 2:
Practice Address - City:HOCKLEY
Practice Address - State:TX
Practice Address - Zip Code:77447-8295
Practice Address - Country:US
Practice Address - Phone:936-931-4420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-27
Last Update Date:2015-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102254235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist