Provider Demographics
NPI:1629591649
Name:KELLEY, ERIN (AUD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:MACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11500 N PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-4625
Mailing Address - Country:US
Mailing Address - Phone:405-608-4569
Mailing Address - Fax:405-548-4349
Practice Address - Street 1:11500 N PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-4625
Practice Address - Country:US
Practice Address - Phone:405-548-4300
Practice Address - Fax:405-548-4350
Is Sole Proprietor?:No
Enumeration Date:2017-07-21
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4752231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist