Provider Demographics
NPI:1801377858
Name:KIRKHAM, KELLIE ANNE (CF-SLP)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:ANNE
Last Name:KIRKHAM
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 OXFORD ST APT 2301
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-2679
Mailing Address - Country:US
Mailing Address - Phone:217-722-0936
Mailing Address - Fax:
Practice Address - Street 1:404 OXFORD ST APT 2301
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-2679
Practice Address - Country:US
Practice Address - Phone:217-722-0936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist