Provider Demographics
NPI:1861668741
Name:MAHAFFEY, KELLI A (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:A
Last Name:MAHAFFEY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MISS
Other - First Name:KELLI
Other - Middle Name:A
Other - Last Name:RHYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:PO BOX 2206
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70527-2206
Mailing Address - Country:US
Mailing Address - Phone:337-788-2300
Mailing Address - Fax:
Practice Address - Street 1:225W 5TH ST
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-4332
Practice Address - Country:US
Practice Address - Phone:337-788-2300
Practice Address - Fax:888-214-8710
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104028235Z00000X
LA6222235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist