Provider Demographics
NPI:1346915816
Name:KELLY, MEGAN (CF-SLP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20953 ANN AVE
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-1963
Mailing Address - Country:US
Mailing Address - Phone:302-388-1930
Mailing Address - Fax:
Practice Address - Street 1:61 CORPORATE CIRCLE
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-2405
Practice Address - Country:US
Practice Address - Phone:302-324-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEO4-0010752235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist