Provider Demographics
NPI:1407961691
Name:KELLEY, MEGAN COURTNEY (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:COURTNEY
Last Name:KELLEY
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 1:286 CASPER DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-9230
Mailing Address - Country:US
Mailing Address - Phone:720-404-0570
Mailing Address - Fax:720-208-0605
Practice Address - Street 1:286 CASPER DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-9230
Practice Address - Country:US
Practice Address - Phone:720-404-0570
Practice Address - Fax:720-208-0605
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12065235235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO416-36-261Medicaid