Provider Demographics
NPI:1952976458
Name:KELLEY, KERI DIANNE
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:DIANNE
Last Name:KELLEY
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 1:3166 HONEYSUCKLE LN N
Mailing Address - Street 2:
Mailing Address - City:SOUTHSIDE
Mailing Address - State:AL
Mailing Address - Zip Code:35907-6608
Mailing Address - Country:US
Mailing Address - Phone:256-328-5129
Mailing Address - Fax:
Practice Address - Street 1:2081 COLUMBIANA RD
Practice Address - Street 2:
Practice Address - City:VESTAVIA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35216-2139
Practice Address - Country:US
Practice Address - Phone:205-991-2584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist