Provider Demographics
NPI:1073075529
Name:LUND, KELLY NICOLE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:NICOLE
Last Name:LUND
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:NICOLE
Other - Last Name:TROUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:94-1181 KA UKA BLVD.
Mailing Address - Street 2:STE C
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797
Mailing Address - Country:US
Mailing Address - Phone:808-260-9056
Mailing Address - Fax:808-444-8353
Practice Address - Street 1:94-1181 KA UKA BLVD.
Practice Address - Street 2:STE C
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797
Practice Address - Country:US
Practice Address - Phone:808-260-9056
Practice Address - Fax:808-444-8353
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist