Provider Demographics
NPI:1720461486
Name:KELLE, ASHLEY LORAINE
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:LORAINE
Last Name:KELLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S WASHINGTON ST # 128
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4539
Mailing Address - Country:US
Mailing Address - Phone:405-368-1515
Mailing Address - Fax:
Practice Address - Street 1:15625 EXPLORER
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:OK
Practice Address - Zip Code:73077-9494
Practice Address - Country:US
Practice Address - Phone:405-368-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-30
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
OK14114931235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist