Provider Demographics
NPI:1629625413
Name:STEWART, KELLI (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 STREAMWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CARLINVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62626-1562
Mailing Address - Country:US
Mailing Address - Phone:217-556-7147
Mailing Address - Fax:
Practice Address - Street 1:214 PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:MORRISONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62546
Practice Address - Country:US
Practice Address - Phone:217-526-8121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist