Individual
KELLY N ROUNDTREE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
15489 DEDEAUX RD, GULFPORT, MS 39503-2667
(228) 806-0616
Mailing address
15489 DEDEAUX RD, GULFPORT, MS 39503-2667
(228) 806-0616
(228) 832-0800
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
S2496
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
S2496
MS SLP LICENSE
MS
Enumeration date
08/12/2019
Last updated
08/12/2019
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