Provider Demographics
NPI:1407414659
Name:BYRNE, KELLI MARIE (HIS)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:MARIE
Last Name:BYRNE
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 CANTERBURY RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-1420
Mailing Address - Country:US
Mailing Address - Phone:856-630-5146
Mailing Address - Fax:
Practice Address - Street 1:126 CANTERBURY RD
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-1420
Practice Address - Country:US
Practice Address - Phone:856-780-5164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1350237700000X
237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist