Provider Demographics
NPI:1386209708
Name:MALCOLM, KELLY ANN (AUD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:MALCOLM
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 HARDY ST
Mailing Address - Street 2:
Mailing Address - City:KNOB NOSTER
Mailing Address - State:MO
Mailing Address - Zip Code:65336-1544
Mailing Address - Country:US
Mailing Address - Phone:660-563-1907
Mailing Address - Fax:
Practice Address - Street 1:2000 OLATHE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-0002
Practice Address - Country:US
Practice Address - Phone:913-588-6701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-01
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KS2943237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program