Provider Demographics
NPI:1164598223
Name:FORD, KELLEY ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:KELLEY
Middle Name:ANN
Last Name:FORD
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 1:19401 40TH AVE W
Mailing Address - Street 2:SUITE 310
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4612
Mailing Address - Country:US
Mailing Address - Phone:425-582-2473
Mailing Address - Fax:425-582-2475
Practice Address - Street 1:19401 40TH AVE W
Practice Address - Street 2:SUITE 310
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4612
Practice Address - Country:US
Practice Address - Phone:425-582-2473
Practice Address - Fax:425-582-2475
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00003769235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4230FOOtherREGENCE LYNNWOOD NUMBER
WA12042972OtherASHA NUMBER
WA7552818OtherAETNA INS. CO. NUMBER
WA8412520Medicaid
WA7028319Medicaid