Individual
HALEY KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
905 BARDOT ST, SAINT CLAIR, MO 63077-1700
(636) 629-3500
Mailing address
5013 COUNTRY RIDGE DR, IMPERIAL, MO 63052-1504
(314) 402-0518
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2020028871
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
460105580
—
MO
Enumeration date
11/02/2021
Last updated
04/06/2026
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