Provider Demographics
NPI:1255504999
Name:KELLY, LOREN C (MS)
Entity Type:Individual
Prefix:
First Name:LOREN
Middle Name:C
Last Name:KELLY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 BLOOMER RD
Mailing Address - Street 2:
Mailing Address - City:LAGRANGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12540-6229
Mailing Address - Country:US
Mailing Address - Phone:845-227-3240
Mailing Address - Fax:845-227-3240
Practice Address - Street 1:232 BLOOMER RD
Practice Address - Street 2:
Practice Address - City:LAGRANGEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12540-6229
Practice Address - Country:US
Practice Address - Phone:845-227-3240
Practice Address - Fax:845-227-3240
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016775235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist