Provider Demographics
NPI:1922270776
Name:KRAUSE, KELLI KATHLEEN (MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:KATHLEEN
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:
Other - Last Name:SHEPOKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5606 S 147TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-2648
Mailing Address - Country:US
Mailing Address - Phone:402-201-4635
Mailing Address - Fax:
Practice Address - Street 1:5606 S 147TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68137
Practice Address - Country:US
Practice Address - Phone:402-201-4635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE910235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE910OtherSPEECH PATHOLOGY