Basic Information
| Provider Information | |||||||||
| NPI: | 1962757583 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAVLEY | ||||||||
| FirstName: | KELLI | ||||||||
| MiddleName: | CHRISTINE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | AU.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3945 OKEMOS RD | ||||||||
| Address2: | STE B1 | ||||||||
| City: | OKEMOS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488644207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173490200 | ||||||||
| FaxNumber: | 5173493030 | ||||||||
| Practice Location | |||||||||
| Address1: | 310 N CLIPPERT ST | ||||||||
| Address2: | STE. 4 | ||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489124694 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173321691 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2012 | ||||||||
| LastUpdateDate: | 05/27/2014 | ||||||||
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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 | 231H00000X | 1601000615 | MI | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.