Provider Demographics
NPI:1033992938
Name:DUNLAP, KELLY
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:DUNLAP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4885 JESSICA SUZANNE DR
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:OH
Mailing Address - Zip Code:45152-8073
Mailing Address - Country:US
Mailing Address - Phone:513-716-8089
Mailing Address - Fax:
Practice Address - Street 1:1797 KING AVE
Practice Address - Street 2:
Practice Address - City:KINGS MILLS
Practice Address - State:OH
Practice Address - Zip Code:45034-1751
Practice Address - Country:US
Practice Address - Phone:513-398-8050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist