Provider Demographics
NPI:1891114195
Name:HAMPTON, KELLIE BRIDGES
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:BRIDGES
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7922
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70722-1922
Mailing Address - Country:US
Mailing Address - Phone:225-683-4637
Mailing Address - Fax:225-683-4637
Practice Address - Street 1:6156 LANIER DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70812-2313
Practice Address - Country:US
Practice Address - Phone:225-683-4637
Practice Address - Fax:225-683-4637
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5964235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist