Provider Demographics
NPI:1215409776
Name:KELLY MINGUS SPEECH PATHOLOGY LLC
Entity Type:Organization
Organization Name:KELLY MINGUS SPEECH PATHOLOGY LLC
Other - Org Name:DREAM BIG PEDIATRIC THERAPIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MINGUS
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:615-651-4833
Mailing Address - Street 1:1402 LILLE CT
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-8584
Mailing Address - Country:US
Mailing Address - Phone:612-816-8950
Mailing Address - Fax:
Practice Address - Street 1:3326 ASPEN GROVE DR STE 312
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-4847
Practice Address - Country:US
Practice Address - Phone:615-651-4833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-21
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech