Provider Demographics
NPI:1295391266
Name:BROWNELL, KELLY A (MA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:BROWNELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CHAUMONT DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3510
Mailing Address - Country:US
Mailing Address - Phone:716-525-2995
Mailing Address - Fax:
Practice Address - Street 1:26 SAN FERNANDO LN
Practice Address - Street 2:
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-2234
Practice Address - Country:US
Practice Address - Phone:716-472-1289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist