Provider Demographics
NPI:1528577269
Name:HUNT, KELLI LYNN (MED, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:LYNN
Last Name:HUNT
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:MRS
Other - First Name:KELLI
Other - Middle Name:MULLIS
Other - Last Name:WHITTINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, CCC-SLP
Mailing Address - Street 1:1015 NE NORTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MAYO
Mailing Address - State:FL
Mailing Address - Zip Code:32066-4289
Mailing Address - Country:US
Mailing Address - Phone:386-294-3940
Mailing Address - Fax:
Practice Address - Street 1:608 SW MARVIN BURNETT RD
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-4918
Practice Address - Country:US
Practice Address - Phone:386-758-4710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5007235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist