Provider Demographics
NPI:1124542121
Name:ESCANDON, KELLY (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:ESCANDON
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 1:3762 ROCKDALE FELLOWSHIP RD
Mailing Address - Street 2:
Mailing Address - City:MT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-7733
Mailing Address - Country:US
Mailing Address - Phone:615-500-6554
Mailing Address - Fax:615-469-4321
Practice Address - Street 1:3762 ROCKDALE FELLOWSHIP RD
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-7733
Practice Address - Country:US
Practice Address - Phone:615-500-6554
Practice Address - Fax:615-469-4321
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-01
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6325235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty