Provider Demographics
NPI:1104361385
Name:RATHBONE, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:RATHBONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ANN
Other - Last Name:CAHILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MASTERS SPEECH PATH
Mailing Address - Street 1:6609 N MARTY AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-0824
Mailing Address - Country:US
Mailing Address - Phone:559-289-5084
Mailing Address - Fax:
Practice Address - Street 1:6609 N MARTY AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-0824
Practice Address - Country:US
Practice Address - Phone:559-289-5084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-27
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7945235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist