Provider Demographics
NPI:1265789556
Name:PARKER, KELLY E (MS, CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:E
Last Name:PARKER
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:E
Other - Last Name:TALLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27 KNOLLWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PURVIS
Mailing Address - State:MS
Mailing Address - Zip Code:39475-3468
Mailing Address - Country:US
Mailing Address - Phone:985-705-6962
Mailing Address - Fax:
Practice Address - Street 1:118 COLLEGE DR
Practice Address - Street 2:#10035
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39406-0001
Practice Address - Country:US
Practice Address - Phone:601-266-5223
Practice Address - Fax:601-266-6763
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS2001235Z00000X
AL3529235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist