Provider Demographics
NPI:1043493919
Name:KELLY, KELLY LYNN (MA CCC-A)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:KELLY
Suffix:
Gender:F
Credentials:MA CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8254 MAYFIELD RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:CHESTERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44026-2593
Mailing Address - Country:US
Mailing Address - Phone:440-729-4325
Mailing Address - Fax:440-729-4357
Practice Address - Street 1:8254 MAYFIELD RD
Practice Address - Street 2:SUITE #6
Practice Address - City:CHESTERLAND
Practice Address - State:OH
Practice Address - Zip Code:44026-2593
Practice Address - Country:US
Practice Address - Phone:440-729-4325
Practice Address - Fax:440-729-4357
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-13
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA. 00194231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist