Provider Demographics
NPI:1023542644
Name:LAWLOR, KELLY (SLP-CFY)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:LAWLOR
Suffix:
Gender:F
Credentials:SLP-CFY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3604 CEDAR SPRINGS RD
Mailing Address - Street 2:APT 338
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4965
Mailing Address - Country:US
Mailing Address - Phone:913-909-1806
Mailing Address - Fax:
Practice Address - Street 1:3604 CEDAR SPRINGS RD
Practice Address - Street 2:APT 338
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4965
Practice Address - Country:US
Practice Address - Phone:913-909-1806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist