Provider Demographics
NPI:1144752031
Name:CAREY, KELLEY (MED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:CAREY
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 LEON ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-4133
Mailing Address - Country:US
Mailing Address - Phone:919-560-3906
Mailing Address - Fax:919-237-5734
Practice Address - Street 1:1001 LEON ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-4133
Practice Address - Country:US
Practice Address - Phone:919-560-3906
Practice Address - Fax:919-237-5734
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12014235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist