Provider Demographics
NPI:1083317481
Name:MCHUGH, KELLY ANN (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:MCHUGH
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 INDIAN MARKER RD
Mailing Address - Street 2:
Mailing Address - City:CONESTOGA
Mailing Address - State:PA
Mailing Address - Zip Code:17516-9302
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 HISTORIC DR STE 117
Practice Address - Street 2:
Practice Address - City:STRASBURG
Practice Address - State:PA
Practice Address - Zip Code:17579-1458
Practice Address - Country:US
Practice Address - Phone:484-367-7131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL014049235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist