Provider Demographics
NPI:1235518630
Name:KELLY, LAURA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3329 SAINT GEORGES WAY
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-1551
Mailing Address - Country:US
Mailing Address - Phone:513-924-2545
Mailing Address - Fax:513-396-5593
Practice Address - Street 1:3329 SAINT GEORGES WAY
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-1551
Practice Address - Country:US
Practice Address - Phone:513-924-2545
Practice Address - Fax:513-396-5593
Is Sole Proprietor?:No
Enumeration Date:2015-05-19
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.11704235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist