Provider Demographics
NPI:1013136753
Name:KELLEY, DEBBIE L (AU D)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:L
Last Name:KELLEY
Suffix:
Gender:F
Credentials:AU D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39506 N DAISY MOUNTAIN DR
Mailing Address - Street 2:SUITE 122-624
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-1663
Mailing Address - Country:US
Mailing Address - Phone:928-284-2116
Mailing Address - Fax:928-496-2122
Practice Address - Street 1:61 BELL ROCK PLZ
Practice Address - Street 2:STE B
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86351-8810
Practice Address - Country:US
Practice Address - Phone:928-284-2116
Practice Address - Fax:928-496-2122
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA1429231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1013136753OtherINDIVIDUAL NPI
AZ1528487014OtherGROUP NPI
AZZ164325OtherPTAN
AZ65373Medicare ID - Type UnspecifiedINDIVIDUAL