Provider Demographics
NPI:1194389908
Name:PFADENHAUER, KELLI LYNN
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:LYNN
Last Name:PFADENHAUER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 GLYNDON DR
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-1605
Mailing Address - Country:US
Mailing Address - Phone:410-887-1130
Mailing Address - Fax:
Practice Address - Street 1:445 GLYNDON DR
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-1605
Practice Address - Country:US
Practice Address - Phone:410-887-1130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist