Provider Demographics
NPI:1235384165
Name:SINN, KELLY O'GARA (MS CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:O'GARA
Last Name:SINN
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:MRS
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:SINN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS CCC/SLP
Mailing Address - Street 1:89 PINE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:NEWFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14867
Mailing Address - Country:US
Mailing Address - Phone:607-564-7729
Mailing Address - Fax:
Practice Address - Street 1:89 PINE CIRCLE
Practice Address - Street 2:
Practice Address - City:NEWFIELD
Practice Address - State:NY
Practice Address - Zip Code:14867
Practice Address - Country:US
Practice Address - Phone:607-564-7729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006367-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist