Doctor Name: | KELLY L WALSH |
NPI Number: | 1518210210 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | SLP007762 |
Business Practice Address: | 4810 Ivy Ridge Dr Se Unit 306 Smyrna, GA - 300806660 |
Business Phone Number: | 6308427107 |
Business Fax Number: | |
Mailing Address: | 4810 Ivy Ridge Dr Se, Unit 306 SMYRNA |
State: | GA |
Postal Code: | 300806660 |
Phone Number: | 6308427107 |
Fax Number: | |
NPI Enumeration Date: | 10/18/2012 |
NPI Last Update Date: | 10/18/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SLP007762 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
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 |