Provider Demographics
NPI:1366197543
Name:RASCO, KELLI DIONN
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:DIONN
Last Name:RASCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6036 96TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-3708
Mailing Address - Country:US
Mailing Address - Phone:806-241-3431
Mailing Address - Fax:
Practice Address - Street 1:101 DONALD PRESTON DR
Practice Address - Street 2:
Practice Address - City:WOLFFORTH
Practice Address - State:TX
Practice Address - Zip Code:79382-5406
Practice Address - Country:US
Practice Address - Phone:806-866-4443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist