Doctor Name: | DINA KELLY |
NPI Number: | 1295126761 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 146.010191 |
Business Practice Address: | 306 W Mill St Carbondale, IL - 629012727 |
Business Phone Number: | 6185293060 |
Business Fax Number: | |
Mailing Address: | 1504 W Taylor Dr, CARBONDALE |
State: | IL |
Postal Code: | 629012222 |
Phone Number: | 6185254587 |
Fax Number: | |
NPI Enumeration Date: | 02/05/2015 |
NPI Last Update Date: | 02/05/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 146.010191 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
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 |