Kelli Renee Hamblen, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

5078 Issued in SC

Practice address

704 21St Ave N
Myrtle Beach, SC 29577-7400

Phone

(843) 448-2913

Fax

(843) 626-1483

NPI assigned

Jun 27, 2012

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

Other names 1

• Miss Kelli Renee Summerfield Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1340755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340755200000",
    "number": "1902160609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2184 BREWSTER DR",
            "address_2": "UNIT 826",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295771752",
            "telephone_number": "304-542-8390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "704 21ST AVE N",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295777400",
            "telephone_number": "843-448-2913",
            "fax_number": "843-626-1483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAMBLEN",
        "first_name": "KELLI",
        "middle_name": "RENEE",
        "name_prefix": "Mrs.",
        "credential": "CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-27",
        "last_updated": "2012-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "SC",
            "license": "5078",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLI",
            "last_name": "SUMMERFIELD",
            "middle_name": "RENEE",
            "prefix": "MISS",
            "credential": "CCC-SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jessica Rose Halford, PA-C
• Stephanie Defeo Hall, APRN
• Jon D Halling, MD
• Irene Dorothy Hallock, FNP
• Sandra M. Halterman, OS, DDS
• Walter Thomas Hambrick
• Debra K Hamerski, CRNA
• Scott A Hamilton, DPM
• Stephen Hammond, M.D
• Jessica Hamrick

• Speech-Language Pathologist in Myrtle Beach, SC
• Providers in Myrtle Beach, SC by specialty
• Speech-Language Pathologist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2012; 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.