Provider Demographics
NPI:1932492683
Name:SPEAKAR, KELLEY DIANE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:DIANE
Last Name:SPEAKAR
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 MEADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-2423
Mailing Address - Country:US
Mailing Address - Phone:660-998-1337
Mailing Address - Fax:
Practice Address - Street 1:501 MEADOWBROOK DR
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-2423
Practice Address - Country:US
Practice Address - Phone:660-998-1337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999139201235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist