Healthcare Provider Details

I. General information

NPI: 1881531648
Provider Name (Legal Business Name): KELLI ANNE KING CHARLES M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 W 3700 N
PROVO UT
84604-4956
US

IV. Provider business mailing address

336 W 3700 N
PROVO UT
84604-4956
US

V. Phone/Fax

Practice location:
  • Phone: 385-208-3722
  • Fax:
Mailing address:
  • Phone: 385-208-3722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number720322
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: