Provider Demographics
NPI:1891055901
Name:KELLEHER, KIM ELIZABETH (MA, SLP)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:ELIZABETH
Last Name:KELLEHER
Suffix:
Gender:F
Credentials:MA, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7888 S FOREST ST
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-3835
Mailing Address - Country:US
Mailing Address - Phone:303-741-3823
Mailing Address - Fax:
Practice Address - Street 1:7888 S FOREST ST
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-3835
Practice Address - Country:US
Practice Address - Phone:303-741-3823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist