Provider Demographics
NPI:1982994174
Name:SIMMONETT, KELLY MARIE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:MARIE
Last Name:SIMMONETT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:MARIE
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6143 W 120TH ST
Mailing Address - Street 2:APT 91
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-3726
Mailing Address - Country:US
Mailing Address - Phone:316-640-2406
Mailing Address - Fax:
Practice Address - Street 1:5211 W 103RD ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66207-3154
Practice Address - Country:US
Practice Address - Phone:913-383-2569
Practice Address - Fax:913-383-2611
Is Sole Proprietor?:No
Enumeration Date:2011-04-09
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2971235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist