Most Relevant Information
Provider Data
| NPI Number: | 1003591769 |
| Provider Name: | KELLI BANTA |
| Entity Type: | Individual |
| Taxonomy Code: | 235Z00000X |
| Specialty: | Speech-Language Pathologist |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/20/2023 |
| Last Updated: | 06/20/2023 |
Provider Practice Location
4805 W 4TH ST
HATTIESBURG
MS
394021019
Practice Location Phone/Fax
| Phone: | 6012706968 |
| Fax: |
Provider Mailing Location
606 CONCART ST
HATTIESBURG
MS
394014213
Provider Mailing Phone/Fax
| Phone: | 5047014709 |
| Fax: |