| Doctor Name: | MRS. KELLY SUZANNE THEIS |
| NPI Number: | 1851661433 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S. SLP |
| License Number: | 018477 |
| Business Practice Address: | 24 Idlewild Ave Cornwall On Hudson, NY - 125201134 |
| Business Phone Number: | 8455348009 |
| Business Fax Number: | |
| Mailing Address: | 30 Bethlehem Rd, NEW WINDSOR |
| State: | NY |
| Postal Code: | 125538903 |
| Phone Number: | 8458637861 |
| Fax Number: | |
| NPI Enumeration Date: | 01/12/2012 |
| NPI Last Update Date: | 01/12/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 018477 |
| 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 |