Provider Demographics
NPI:1750645073
Name:HALTERMAN, KELLY JEAN (AUD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:JEAN
Last Name:HALTERMAN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22425 N 96TH LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-4194
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8877 W UNION HILLS DR STE 350
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-3026
Practice Address - Country:US
Practice Address - Phone:623-428-0727
Practice Address - Fax:623-738-3918
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA7844231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist