Provider Demographics
NPI:1629340468
Name:BAUMERT, KELLI KAY (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:KAY
Last Name:BAUMERT
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7928 N 154TH AVE
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68007-1820
Mailing Address - Country:US
Mailing Address - Phone:402-213-2634
Mailing Address - Fax:402-315-9056
Practice Address - Street 1:7928 N 154TH AVE
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:NE
Practice Address - Zip Code:68007-1820
Practice Address - Country:US
Practice Address - Phone:402-213-2634
Practice Address - Fax:402-315-9056
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1010235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist