Provider Demographics
NPI:1376860221
Name:JAMES, KELLYE A (MS/CCC/SLP)
Entity Type:Individual
Prefix:
First Name:KELLYE
Middle Name:A
Last Name:JAMES
Suffix:
Gender:F
Credentials:MS/CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5535
Mailing Address - Country:US
Mailing Address - Phone:501-554-4243
Mailing Address - Fax:
Practice Address - Street 1:301 N CEDAR ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5535
Practice Address - Country:US
Practice Address - Phone:501-554-4243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR516235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist