Provider Demographics
NPI:1073915740
Name:ROSTORFER, KELLY (AUD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:
Last Name:ROSTORFER
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5074 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-1526
Mailing Address - Country:US
Mailing Address - Phone:614-431-1010
Mailing Address - Fax:
Practice Address - Street 1:5074 N HIGH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1526
Practice Address - Country:US
Practice Address - Phone:614-431-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1900231H00000X
OHA01972231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist