Provider Demographics
NPI:1568126449
Name:OCKER, KELLI LYN (MS)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:LYN
Last Name:OCKER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:LYN
Other - Last Name:DUSHANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:713 LONE PINE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-2727
Mailing Address - Country:US
Mailing Address - Phone:713-447-8051
Mailing Address - Fax:
Practice Address - Street 1:633 FRENCH SETTLEMENT RD
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-3230
Practice Address - Country:US
Practice Address - Phone:972-947-9458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX235Z00000X
TX118483235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist