Provider Demographics
NPI:1275978488
Name:CADDEN, KELLY LLOYD (MCD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LLOYD
Last Name:CADDEN
Suffix:
Gender:F
Credentials:MCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 LEE DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36832-6722
Mailing Address - Country:US
Mailing Address - Phone:770-490-6025
Mailing Address - Fax:
Practice Address - Street 1:2290 MOORES MILL RD
Practice Address - Street 2:SUITE 400
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-8431
Practice Address - Country:US
Practice Address - Phone:334-209-2009
Practice Address - Fax:334-209-2109
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3464235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist