Doctor Name: | MRS. KELLY KONGVOLD-GLASS |
NPI Number: | 1255584512 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS, CCC-SLP |
License Number: | 016527-1 |
Business Practice Address: | 14 Bridgewaters Dr Ste A Oceanport, NJ - 077571184 |
Business Phone Number: | 7325426600 |
Business Fax Number: | 7325426606 |
Mailing Address: | 14 Bridgewaters Dr Ste A, OCEANPORT |
State: | NJ |
Postal Code: | 077571184 |
Phone Number: | 7325426600 |
Fax Number: | 7325426606 |
NPI Enumeration Date: | 10/30/2008 |
NPI Last Update Date: | 09/15/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 016527-1 |
Healthcare Provider Taxonomy: (Secondary) | N |
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 |