Provider Demographics
NPI:1124415906
Name:CONLIN, KELLY MARIA (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIA
Last Name:CONLIN
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 DAVIS AVE
Mailing Address - Street 2:APT. 2B
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-1031
Mailing Address - Country:US
Mailing Address - Phone:516-660-9980
Mailing Address - Fax:
Practice Address - Street 1:47 DAVIS AVE
Practice Address - Street 2:APT. 2B
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1031
Practice Address - Country:US
Practice Address - Phone:516-660-9980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024293235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist