Provider Demographics
NPI:1205115433
Name:BEHME, KELLY SUZANNE (MA CCC-SLP/L)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:SUZANNE
Last Name:BEHME
Suffix:
Gender:F
Credentials:MA CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 108
Mailing Address - Street 2:
Mailing Address - City:CARLINVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62626-0108
Mailing Address - Country:US
Mailing Address - Phone:309-660-1167
Mailing Address - Fax:
Practice Address - Street 1:14658 BEHME RD
Practice Address - Street 2:
Practice Address - City:CARLINVILLE
Practice Address - State:IL
Practice Address - Zip Code:62626-2392
Practice Address - Country:US
Practice Address - Phone:309-660-1167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146006767235Z00000X
TX103331235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist