Provider Demographics
NPI:1609594654
Name:ADAMS, KELLY RENEE
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:RENEE
Last Name:ADAMS
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 1:103 DOVE MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78639-2102
Mailing Address - Country:US
Mailing Address - Phone:512-734-2979
Mailing Address - Fax:
Practice Address - Street 1:207 W 8TH ST
Practice Address - Street 2:
Practice Address - City:LAMPASAS
Practice Address - State:TX
Practice Address - Zip Code:76550-3125
Practice Address - Country:US
Practice Address - Phone:512-564-2734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17695235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX17695OtherTEXAS DEPARTMENT OF LICENSING AND REGULATION