Provider Demographics
NPI:1902160609
Name:HAMBLEN, KELLI RENEE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:RENEE
Last Name:HAMBLEN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MISS
Other - First Name:KELLI
Other - Middle Name:RENEE
Other - Last Name:SUMMERFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:2184 BREWSTER DR
Mailing Address - Street 2:UNIT 826
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-1752
Mailing Address - Country:US
Mailing Address - Phone:304-542-8390
Mailing Address - Fax:
Practice Address - Street 1:704 21ST AVE N
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-7400
Practice Address - Country:US
Practice Address - Phone:843-448-2913
Practice Address - Fax:843-626-1483
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5078235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist