Provider Demographics
NPI:1952459232
Name:KELLAM, CHRISTOPHER N (TSLP)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:N
Last Name:KELLAM
Suffix:
Gender:M
Credentials:TSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 W FORDHAM DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-2841
Mailing Address - Country:US
Mailing Address - Phone:260-414-2366
Mailing Address - Fax:602-866-2261
Practice Address - Street 1:3233 W PEORIA AVE
Practice Address - Street 2:SUITE 224
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4614
Practice Address - Country:US
Practice Address - Phone:602-866-2231
Practice Address - Fax:602-866-2261
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP5360235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist