Provider Demographics
NPI:1932944154
Name:WHITLEY, KELLI NICOLE
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:NICOLE
Last Name:WHITLEY
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 1:200 PLAZA DR # 3110
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2348
Mailing Address - Country:US
Mailing Address - Phone:720-627-6378
Mailing Address - Fax:
Practice Address - Street 1:200 PLAZA DR # 3110
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2348
Practice Address - Country:US
Practice Address - Phone:720-627-6378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAUD.0001277231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist