Provider Demographics
NPI:1790093193
Name:KELLAR, LINDA H (MSP, CCC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:H
Last Name:KELLAR
Suffix:
Gender:F
Credentials:MSP, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61382 JACK WILLIAMS RD
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-8046
Mailing Address - Country:US
Mailing Address - Phone:985-732-4664
Mailing Address - Fax:985-732-9346
Practice Address - Street 1:61382 JACK WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-8046
Practice Address - Country:US
Practice Address - Phone:985-732-4664
Practice Address - Fax:985-732-9346
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3267235Z00000X
TX105130235Z00000X
FL10583235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist