Doctor Name: | MICHAEL JOHN KELLY |
NPI Number: | 1871949115 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MS, CCC-SLP |
License Number: | 124737 |
Business Practice Address: | 3484 Fair Oaks Ave Bowling Green, KY - 421045529 |
Business Phone Number: | 2707795257 |
Business Fax Number: | |
Mailing Address: | 3484 Fair Oaks Ave, BOWLING GREEN |
State: | KY |
Postal Code: | 421045529 |
Phone Number: | 2707795257 |
Fax Number: | |
NPI Enumeration Date: | 05/05/2016 |
NPI Last Update Date: | 05/05/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 124737 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KY |
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 |