Provider Demographics
NPI:1134420573
Name:KELLUM, JANE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:KELLUM
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 1:1505 MILSAP ROAD
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070
Mailing Address - Country:US
Mailing Address - Phone:214-538-2307
Mailing Address - Fax:
Practice Address - Street 1:1505 MILSAP RD
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-5078
Practice Address - Country:US
Practice Address - Phone:214-538-2307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-16
Last Update Date:2018-08-29
Deactivation Date:2016-12-09
Deactivation Code:
Reactivation Date:2018-08-29
Provider Licenses
StateLicense IDTaxonomies
TX15698235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist