Individual
KELTY WICKHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6626 E ANAZAZI DR, FLAGSTAFF, AZ 86004-7153
(408) 300-8526
Mailing address
6626 E ANAZAZI DR, FLAGSTAFF, AZ 86004-7153
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
08/23/2021
Last updated
08/23/2021
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