Doctor Name: | KELLY MOWRY |
NPI Number: | 1467836445 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 2202007905 |
Business Practice Address: | 10700 Ballantraye Dr Suite 102 Fredericksburg, VA - 224074700 |
Business Phone Number: | 5407202261 |
Business Fax Number: | 5407205660 |
Mailing Address: | 10700 Ballantraye Dr, Suite 102 FREDERICKSBURG |
State: | VA |
Postal Code: | 224074700 |
Phone Number: | 5407202261 |
Fax Number: | 5407205660 |
NPI Enumeration Date: | 07/19/2015 |
NPI Last Update Date: | 07/19/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 2202007905 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
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 |