Provider Demographics
NPI:1295996536
Name:CHARITY, KELLIE CELESTINE (SLP)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:CELESTINE
Last Name:CHARITY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 NOBLE POINT ST
Mailing Address - Street 2:
Mailing Address - City:HORIZON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79928-2145
Mailing Address - Country:US
Mailing Address - Phone:915-345-9191
Mailing Address - Fax:
Practice Address - Street 1:14521 HORIZON BLVD
Practice Address - Street 2:
Practice Address - City:HORIZON CITY
Practice Address - State:TX
Practice Address - Zip Code:79928-8564
Practice Address - Country:US
Practice Address - Phone:915-926-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104175235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX676633Medicare PIN