Provider Demographics
NPI:1457447526
Name:HAWKINS, KELLY WEATHERS (MS CCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:WEATHERS
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:MS CCCSLP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:MICHELLE
Other - Last Name:WEATHERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14 E AYERS ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-3667
Mailing Address - Country:US
Mailing Address - Phone:405-513-8186
Mailing Address - Fax:800-680-9132
Practice Address - Street 1:14 E AYERS ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-3667
Practice Address - Country:US
Practice Address - Phone:405-513-8186
Practice Address - Fax:800-680-9132
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3156235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200059840 AMedicaid