Provider Demographics
NPI:1073767976
Name:KELLY, REBECCA N (MSED CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:N
Last Name:KELLY
Suffix:
Gender:F
Credentials:MSED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 HOLLENBECK DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-1619
Mailing Address - Country:US
Mailing Address - Phone:845-527-9669
Mailing Address - Fax:
Practice Address - Street 1:8 HOLLENBECK DR
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-1619
Practice Address - Country:US
Practice Address - Phone:845-527-9669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015074-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist