Provider Demographics
NPI:1316363260
Name:NOVELLI, KELLIANNE
Entity Type:Individual
Prefix:
First Name:KELLIANNE
Middle Name:
Last Name:NOVELLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 PRESIDENT ST APT 4B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-6210
Mailing Address - Country:US
Mailing Address - Phone:303-524-4050
Mailing Address - Fax:
Practice Address - Street 1:1026 PRESIDENT ST APT 4B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-6210
Practice Address - Country:US
Practice Address - Phone:303-524-4050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-14
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist