Provider Demographics
NPI:1962061580
Name:JAMES, KELLY SHARP (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:SHARP
Last Name:JAMES
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3425 COVE CT
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-8496
Mailing Address - Country:US
Mailing Address - Phone:985-502-0879
Mailing Address - Fax:
Practice Address - Street 1:3425 COVE CT
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-8496
Practice Address - Country:US
Practice Address - Phone:985-502-0879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4954235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist