Provider Demographics
NPI:1225085269
Name:HUME-JOHNSON, KELLY A (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:A
Last Name:HUME-JOHNSON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:A
Other - Last Name:HUME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:410 BISHOP ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5448
Mailing Address - Country:US
Mailing Address - Phone:410-218-9827
Mailing Address - Fax:
Practice Address - Street 1:410 BISHOP ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157
Practice Address - Country:US
Practice Address - Phone:410-218-9827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02426235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKJ47/64276801OtherCAREFIRST MARYLAND GBMC
MD406110100Medicaid
MDS1290026OtherCAREFIRST REGIONAL GBMC