Doctor Name: | KIM C KELLY |
NPI Number: | 1689950800 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | SLP |
License Number: | 58007848 |
Business Practice Address: | 678 Cantiague Rock Rd Jericho, NY - 117531401 |
Business Phone Number: | 5162033600 |
Business Fax Number: | |
Mailing Address: | 20 Dale Rd, HALESITE |
State: | NY |
Postal Code: | 117431423 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 11/02/2011 |
NPI Last Update Date: | 11/02/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 58007848 |
Healthcare Provider Taxonomy: (Secondary) | Y |
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 |