Provider Demographics
NPI:1447395249
Name:CONSTABLE, KELLY (MS)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:CONSTABLE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 419161
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-9161
Mailing Address - Country:US
Mailing Address - Phone:314-523-5395
Mailing Address - Fax:314-523-5795
Practice Address - Street 1:226 S WOODS MILL RD
Practice Address - Street 2:SUITE 37W
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3662
Practice Address - Country:US
Practice Address - Phone:314-523-5395
Practice Address - Fax:314-523-5795
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007001604231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00639806OtherRAILROAD MEDICARE
MO337799407Medicaid
MO337799407Medicaid