Healthcare Provider Details

I. General information

NPI: 1407710205
Provider Name (Legal Business Name): KELCIE WEHRUM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 S HOLLYWOOD ST
MEMPHIS TN
38112-4801
US

IV. Provider business mailing address

160 S HOLLYWOOD ST
MEMPHIS TN
38112-4801
US

V. Phone/Fax

Practice location:
  • Phone: 901-416-5300
  • Fax: 901-416-5300
Mailing address:
  • Phone: 901-416-5300
  • Fax: 901-416-5300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number8643
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: