Provider Demographics
NPI:1972860906
Name:THOMPSON, KELI R
Entity Type:Individual
Prefix:
First Name:KELI
Middle Name:R
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELI
Other - Middle Name:
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SLP
Mailing Address - Street 1:PO BOX 312
Mailing Address - Street 2:
Mailing Address - City:PANHANDLE
Mailing Address - State:TX
Mailing Address - Zip Code:79068-0312
Mailing Address - Country:US
Mailing Address - Phone:806-274-1342
Mailing Address - Fax:
Practice Address - Street 1:312 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:PANHANDLE
Practice Address - State:TX
Practice Address - Zip Code:79068
Practice Address - Country:US
Practice Address - Phone:806-274-1342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104539235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist