| Doctor Name: | KELLI DE WAARD |
| NPI Number: | 1073962346 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, CCC-SLP |
| License Number: | 558-PROV |
| Business Practice Address: | 1216 N Garfield Ave Dell Rapids, SD - 570221837 |
| Business Phone Number: | 6054285473 |
| Business Fax Number: | |
| Mailing Address: | 6509 W Alyssum St, SIOUX FALLS |
| State: | SD |
| Postal Code: | 571071605 |
| Phone Number: | 6052617893 |
| Fax Number: | |
| NPI Enumeration Date: | 06/08/2016 |
| NPI Last Update Date: | 06/08/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 558-PROV |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SD |
| 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 |