Provider Demographics
NPI:1144704164
Name:MESSMORE, KELLY C (MS, CCC-SLP/L)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:C
Last Name:MESSMORE
Suffix:
Gender:F
Credentials:MS, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 KAITLIN CT
Mailing Address - Street 2:
Mailing Address - City:EAST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61611-3464
Mailing Address - Country:US
Mailing Address - Phone:309-287-9523
Mailing Address - Fax:
Practice Address - Street 1:1907 W FORREST HILL AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61604-1919
Practice Address - Country:US
Practice Address - Phone:309-672-6571
Practice Address - Fax:309-688-0320
Is Sole Proprietor?:No
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146007411235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist