Provider Demographics
NPI:1053344754
Name:BURRELL, KELLY DENISE (MS,SLP-CCC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:DENISE
Last Name:BURRELL
Suffix:
Gender:F
Credentials:MS,SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 BILL OWENS PKWY
Mailing Address - Street 2:#201
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-2115
Mailing Address - Country:US
Mailing Address - Phone:903-753-8499
Mailing Address - Fax:903-753-8502
Practice Address - Street 1:822 N 4TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5433
Practice Address - Country:US
Practice Address - Phone:903-753-8499
Practice Address - Fax:903-753-8502
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24679235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist