Provider Demographics
NPI:1073152427
Name:BROPHY, KELLY ADELE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ADELE
Last Name:BROPHY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 E. ILIFF AVE.
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-3462
Mailing Address - Country:US
Mailing Address - Phone:541-633-5288
Mailing Address - Fax:
Practice Address - Street 1:9900 E. ILIFF AVE.
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-3462
Practice Address - Country:US
Practice Address - Phone:303-636-2171
Practice Address - Fax:303-636-5614
Is Sole Proprietor?:No
Enumeration Date:2020-01-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR016691235Z00000X
COSLP.0004314235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist