Provider Demographics
NPI:1336672732
Name:CUNNINGHAM, KELCI LAYNE (CF, MS-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KELCI
Middle Name:LAYNE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:CF, MS-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17284 E 1580 RD
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:OK
Mailing Address - Zip Code:73550-7504
Mailing Address - Country:US
Mailing Address - Phone:580-318-3669
Mailing Address - Fax:
Practice Address - Street 1:401 W TAMARACK RD
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-1529
Practice Address - Country:US
Practice Address - Phone:580-482-7308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKSP#4445235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist