Provider Demographics
NPI:1043561210
Name:PARKER, KELLY C (MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:C
Last Name:PARKER
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 ALLEN ST
Mailing Address - Street 2:SPEECH PATHOLOGY DEPARTMENT
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4560
Mailing Address - Country:US
Mailing Address - Phone:802-747-1834
Mailing Address - Fax:802-747-3856
Practice Address - Street 1:160 ALLEN ST
Practice Address - Street 2:SPEECH PATHOLOGY DEPARTMENT
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4560
Practice Address - Country:US
Practice Address - Phone:802-747-1834
Practice Address - Fax:802-747-3856
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist