Kelli Kidd, MS,CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

3375 Issued in AL

Practice address

2804 Greenhill Blvd NW
Suite 102
Fort Payne, AL 35968-3066

Phone

(256) 979-1222

Fax

(256) 979-1223

NPI assigned

Mar 23, 2015

Last updated

Mar 23, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Go Play Therapy, L.L.C.

  • Specialist
  • Fort Payne, AL
  • NPI 1912406927
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1427068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427068800000",
    "number": "1740674316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2804 GREENHILL BLVD NW",
            "address_2": "SUITE 102",
            "city": "FORT PAYNE",
            "state": "AL",
            "postal_code": "359683066",
            "telephone_number": "256-979-1222",
            "fax_number": "256-979-1223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2804 GREENHILL BLVD NW",
            "address_2": "SUITE 102",
            "city": "FORT PAYNE",
            "state": "AL",
            "postal_code": "359683066",
            "telephone_number": "256-979-1222",
            "fax_number": "256-979-1223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIDD",
        "first_name": "KELLI",
        "credential": "MS,CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-23",
        "last_updated": "2015-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "AL",
            "license": "3375",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Fort Payne, AL
• Providers in Fort Payne, AL by specialty
• Speech-Language Pathologist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.