Provider Demographics
NPI:1215298955
Name:KELLEY, STACY ANN (MS,CCC-SLP)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:ANN
Last Name:KELLEY
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:ANN
Other - Last Name:KAUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,CCC-SLP
Mailing Address - Street 1:6220 PAINSWICK DR
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-2927
Mailing Address - Country:US
Mailing Address - Phone:918-260-1023
Mailing Address - Fax:
Practice Address - Street 1:4800 S HIGHWAY 377 STE 400
Practice Address - Street 2:
Practice Address - City:AUBREY
Practice Address - State:TX
Practice Address - Zip Code:76227-4928
Practice Address - Country:US
Practice Address - Phone:918-260-1023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3907235Z00000X
TX122730235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist