Provider Demographics
NPI:1841690278
Name:SIMMONS, KELLY (MS)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 JOY ST APT A8
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-6480
Mailing Address - Country:US
Mailing Address - Phone:610-639-7607
Mailing Address - Fax:
Practice Address - Street 1:7101 JOY ST APT A8
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-6480
Practice Address - Country:US
Practice Address - Phone:610-639-7607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ6831235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist