| Doctor Name: | KELLY JO PREMO |
| NPI Number: | 1891117990 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S. CCC SLP |
| License Number: | 022776-1 |
| Business Practice Address: | 29 Englewood Ave E Greenbush, NY - 120613900 |
| Business Phone Number: | 5184777103 |
| Business Fax Number: | |
| Mailing Address: | 2500 Pond Vw, CASTLETON ON HUDSON |
| State: | NY |
| Postal Code: | 120339750 |
| Phone Number: | 5184776072 |
| Fax Number: | |
| NPI Enumeration Date: | 01/09/2014 |
| NPI Last Update Date: | 01/09/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 022776-1 |
| 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 |