Provider Demographics
NPI:1336515485
Name:DAY, KELLY NICOLE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:NICOLE
Last Name:DAY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:NICOLE
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8649 NARCISSUS AVE
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33777-3339
Mailing Address - Country:US
Mailing Address - Phone:813-454-3981
Mailing Address - Fax:
Practice Address - Street 1:1858 N ALAFAYA TRL STE 207
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-4754
Practice Address - Country:US
Practice Address - Phone:407-900-5313
Practice Address - Fax:888-972-5443
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ 7191235Z00000X
FLSA15823235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015487400Medicaid