Provider Demographics
NPI:1306373303
Name:MAGUIRE, KELLY FRANCES (MA CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:KELLY
Middle Name:FRANCES
Last Name:MAGUIRE
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 1:148 BEACH 94TH ST APT 5
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11693-1552
Mailing Address - Country:US
Mailing Address - Phone:914-262-9201
Mailing Address - Fax:
Practice Address - Street 1:110 CHESTER ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-5643
Practice Address - Country:US
Practice Address - Phone:718-385-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
027765235Z00000X
NY027765235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist