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Individual
KELLY A TUCKER
Active
Individual
KELLY A TUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MCD, CCC-SLP
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1810
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
515-38005
BLUECROSS BLUESHIELD
AL
Enumeration date
01/29/2007
Last updated
07/08/2007
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