Doctor Name: | KELLY DENISE BURRELL |
NPI Number: | 1053344754 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS,SLP-CCC |
License Number: | 24679 |
Business Practice Address: | 822 N 4th St Longview, TX - 756015433 |
Business Phone Number: | 9037538499 |
Business Fax Number: | 9037538502 |
Mailing Address: | 2801 Bill Owens Pkwy, #201 LONGVIEW |
State: | TX |
Postal Code: | 756052115 |
Phone Number: | 9037538499 |
Fax Number: | 9037538502 |
NPI Enumeration Date: | 07/08/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 24679 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |