Provider Demographics
NPI:1649617770
Name:FETT, KELCI LYNN
Entity type:Individual
Prefix:
First Name:KELCI
Middle Name:LYNN
Last Name:FETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELCI
Other - Middle Name:LYNN
Other - Last Name:BRANNEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 461
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:IA
Mailing Address - Zip Code:50201-0461
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:630 6TH ST
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:IA
Practice Address - Zip Code:50201-2266
Practice Address - Country:US
Practice Address - Phone:515-382-2543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002352235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA002352OtherSTATE LICENSE NUMBER