Basic Information
| Provider Information | |||||||||
| NPI: | 1639628985 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SLEMP | ||||||||
| FirstName: | KELLI | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | SLP-CCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4207 S DALE MABRY HWY UNIT 3209 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336111433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6783864653 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2111 W SWANN AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336062478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132511618 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2016 | ||||||||
| LastUpdateDate: | 04/13/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SA16104 | FL | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | SZ7847 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 018911800 | 05 | FL | MEDICAID |