Provider Demographics
NPI:1285819854
Name:KELLY-CHAMOUN, MAUREEN PATRICIA (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:PATRICIA
Last Name:KELLY-CHAMOUN
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 1:130 FOX HILL RD
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-2716
Mailing Address - Country:US
Mailing Address - Phone:781-433-8634
Mailing Address - Fax:
Practice Address - Street 1:500 CHAPMAN ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-2093
Practice Address - Country:US
Practice Address - Phone:781-821-9950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASL-3146235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist