Provider Demographics
NPI:1487193223
Name:SUMMERS, KELLIE (CCC-SLP, MS)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:CCC-SLP, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 BIG BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-8737
Mailing Address - Country:US
Mailing Address - Phone:828-545-0323
Mailing Address - Fax:
Practice Address - Street 1:46 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-6701
Practice Address - Country:US
Practice Address - Phone:828-246-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11732235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist