Provider Demographics
NPI:1538366885
Name:KELLEY, SHERRYL ANNE (SLP-MA)
Entity type:Individual
Prefix:MRS
First Name:SHERRYL
Middle Name:ANNE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:SLP-MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 NE QUAIL WALK DR
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-6538
Mailing Address - Country:US
Mailing Address - Phone:816-220-3290
Mailing Address - Fax:
Practice Address - Street 1:351 N W GREGORY BLVD
Practice Address - Street 2:
Practice Address - City:LEE,S SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064
Practice Address - Country:US
Practice Address - Phone:816-373-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005013493235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist