Provider Demographics
NPI:1497986004
Name:HOGUE, KELLYE MICHELLE
Entity Type:Individual
Prefix:MRS
First Name:KELLYE
Middle Name:MICHELLE
Last Name:HOGUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:TILLAR
Mailing Address - State:AR
Mailing Address - Zip Code:71670-8510
Mailing Address - Country:US
Mailing Address - Phone:870-222-8115
Mailing Address - Fax:
Practice Address - Street 1:448 SIDNEY BAKER S STE 103
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5980
Practice Address - Country:US
Practice Address - Phone:830-896-3130
Practice Address - Fax:830-896-3132
Is Sole Proprietor?:No
Enumeration Date:2009-07-30
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX350522355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant