Provider Demographics
NPI:1457644817
Name:HUNNICUTT, KELLY JO (MA CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:JO
Last Name:HUNNICUTT
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1865 VIA DELLE ARTI
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89044-0257
Mailing Address - Country:US
Mailing Address - Phone:702-505-1607
Mailing Address - Fax:
Practice Address - Street 1:1865 VIA DELLE ARTI
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89044-0257
Practice Address - Country:US
Practice Address - Phone:702-505-1607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP 585235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist