Provider Demographics
NPI:1922792126
Name:KELLAS, SYDNEY E (SLP)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:E
Last Name:KELLAS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8125 NW 159TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5803
Mailing Address - Country:US
Mailing Address - Phone:305-797-1771
Mailing Address - Fax:
Practice Address - Street 1:1505 RENAISSANCE BLVD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3018
Practice Address - Country:US
Practice Address - Phone:405-850-8497
Practice Address - Fax:405-300-0643
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKCF510235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty