Provider Demographics
NPI:1063665248
Name:MURPHY, KELLEY K (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:K
Last Name:MURPHY
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 1:9 MORONE PL
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1705
Mailing Address - Country:US
Mailing Address - Phone:518-461-6155
Mailing Address - Fax:
Practice Address - Street 1:9 MORONE PL
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1705
Practice Address - Country:US
Practice Address - Phone:518-461-6155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016616-1235Z00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist