Provider Demographics
NPI:1043795974
Name:MEYER, KELLY MORGAN (SLP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:MORGAN
Last Name:MEYER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:MORGAN
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:25432 COLLIGAN ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:IL
Mailing Address - Zip Code:60442-1419
Mailing Address - Country:US
Mailing Address - Phone:815-412-4411
Mailing Address - Fax:
Practice Address - Street 1:25432 COLLIGAN ST
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:IL
Practice Address - Zip Code:60442-1419
Practice Address - Country:US
Practice Address - Phone:815-412-4411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14074194235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist