Provider Demographics
NPI:1689151292
Name:POTTER, KELLI LEE (HAD)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:LEE
Last Name:POTTER
Suffix:
Gender:F
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 W HIGGINS RD STE 895
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-7228
Mailing Address - Country:US
Mailing Address - Phone:843-847-1900
Mailing Address - Fax:517-847-1901
Practice Address - Street 1:1651 W LAKE LANSING RD STE 200
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6337
Practice Address - Country:US
Practice Address - Phone:517-324-5704
Practice Address - Fax:517-324-7038
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501005605237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist