Provider Demographics
NPI:1346776127
Name:LOVELAND, KELLI R (AUD)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:R
Last Name:LOVELAND
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:
Other - Last Name:REDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5546
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-5546
Mailing Address - Country:US
Mailing Address - Phone:801-475-3481
Mailing Address - Fax:801-475-3414
Practice Address - Street 1:1551 RENAISSANCE TOWNE DR
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010
Practice Address - Country:US
Practice Address - Phone:801-295-5581
Practice Address - Fax:801-295-9253
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10362664-4103231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1346776127Medicaid