Provider Demographics
NPI:1457313041
Name:FESLER, KELLIE MORGAN (CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:MORGAN
Last Name:FESLER
Suffix:
Gender:F
Credentials:CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 NORTH OAK ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31601
Mailing Address - Country:US
Mailing Address - Phone:229-241-7299
Mailing Address - Fax:229-241-7986
Practice Address - Street 1:700 NORTH OAK ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601
Practice Address - Country:US
Practice Address - Phone:229-241-7299
Practice Address - Fax:229-241-7986
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAST0003728235Z00000X
FLSA4032235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist