Provider Demographics
NPI:1750512067
Name:FISCHER, KELLY HYDE (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:HYDE
Last Name:FISCHER
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 1:10433 RIVERCREST DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-1401
Mailing Address - Country:US
Mailing Address - Phone:501-228-0133
Mailing Address - Fax:
Practice Address - Street 1:12701 HINSON RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-3301
Practice Address - Country:US
Practice Address - Phone:501-604-1930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR991235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist