| Doctor Name: | MS. ALISSA KELLY |
| NPI Number: | 1902221906 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | C-5442 |
| Business Practice Address: | 401 N 2nd St Grants, NM - 870202507 |
| Business Phone Number: | 5052852600 |
| Business Fax Number: | |
| Mailing Address: | 9215 Clinton Anderson Dr Nw, ALBUQUERQUE |
| State: | NM |
| Postal Code: | 871145318 |
| Phone Number: | 5055737236 |
| Fax Number: | |
| NPI Enumeration Date: | 02/27/2014 |
| NPI Last Update Date: | 02/27/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | C-5442 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| 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 |