Provider Demographics
NPI:1952291585
Name:HUMPHREY, KELLI
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 MARLTON PIKE E STE J51
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-4106
Mailing Address - Country:US
Mailing Address - Phone:856-200-8392
Mailing Address - Fax:856-288-1672
Practice Address - Street 1:1930 MARLTON PIKE E STE J51
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-4106
Practice Address - Country:US
Practice Address - Phone:856-200-8392
Practice Address - Fax:856-288-1672
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTL-4790235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist