Provider Demographics
NPI:1972745867
Name:SCOTT, KELLI ANN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:ANN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1433 GRAND AVENUE PKWY STE 301
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-2067
Mailing Address - Country:US
Mailing Address - Phone:512-251-3230
Mailing Address - Fax:512-251-8760
Practice Address - Street 1:1433 GRAND AVENUE PKWY STE 301
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-2067
Practice Address - Country:US
Practice Address - Phone:512-251-3230
Practice Address - Fax:512-251-8760
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103807235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist