| Doctor Name: | MRS. KELLY BROOKE DESTEFANO |
| NPI Number: | 1073652194 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 7850 |
| Business Practice Address: | 5509 Point Lake Ct Holly Springs, NC - 275409349 |
| Business Phone Number: | 9196562901 |
| Business Fax Number: | 8888934354 |
| Mailing Address: | 1914 Kirkwood Ridge Dr, RALEIGH |
| State: | NC |
| Postal Code: | 276122877 |
| Phone Number: | 9197106477 |
| Fax Number: | |
| NPI Enumeration Date: | 02/05/2007 |
| NPI Last Update Date: | 08/29/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 7850 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| 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 |