Provider Demographics
NPI:1134590094
Name:KREFFT, KELLIE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:KREFFT
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 1:2517 EASTLAKE AVE E STE 102
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3278
Mailing Address - Country:US
Mailing Address - Phone:206-322-5433
Mailing Address - Fax:206-322-7545
Practice Address - Street 1:2627 EASTLAKE AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3213
Practice Address - Country:US
Practice Address - Phone:206-322-5433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-16
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60565781235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist