Doctor Name: | STACI MICHELLE KELLUM |
NPI Number: | 1578905600 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S., CCC-SLP |
License Number: | S3769 |
Business Practice Address: | 951 Frontage Rd Unit 34 Oxford, MS - 386555137 |
Business Phone Number: | 6628167989 |
Business Fax Number: | |
Mailing Address: | 951 Frontage Rd Unit 34, OXFORD |
State: | MS |
Postal Code: | 386555137 |
Phone Number: | 6628167989 |
Fax Number: | |
NPI Enumeration Date: | 07/17/2013 |
NPI Last Update Date: | 07/17/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | S3769 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
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 |