Doctor Name: | LISA ANN KELLY |
NPI Number: | 1033342795 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS CC-SLP |
License Number: | 0162961 |
Business Practice Address: | 33 Winding Path Apt 20 Manorville, NY - 119492276 |
Business Phone Number: | 6319091733 |
Business Fax Number: | |
Mailing Address: | 33 Winding Path, MANORVILLE |
State: | NY |
Postal Code: | 119492276 |
Phone Number: | 6319091733 |
Fax Number: | |
NPI Enumeration Date: | 08/28/2009 |
NPI Last Update Date: | 08/28/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 0162961 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |