Provider Demographics
NPI:1093936213
Name:O'BRIEN, KELLY JULIAN (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:JULIAN
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:ANNE
Other - Last Name:JULIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:101 MANNING DR
Mailing Address - Street 2:G0303 NEUROSCIENCES HOSPITAL
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-4220
Mailing Address - Country:US
Mailing Address - Phone:919-966-2029
Mailing Address - Fax:
Practice Address - Street 1:101 MANNING DR
Practice Address - Street 2:G0303 NEUROSCIENCES HOSPITAL
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-4220
Practice Address - Country:US
Practice Address - Phone:919-966-2029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7359235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist