Provider Demographics
NPI:1417276858
Name:KELLY, CHRISTINA (SLP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9104 BABCOCK BLVD
Mailing Address - Street 2:SUITE 3112
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-5818
Mailing Address - Country:US
Mailing Address - Phone:412-366-3889
Mailing Address - Fax:412-364-6160
Practice Address - Street 1:100 S JACKSON AVE # A
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15202-3428
Practice Address - Country:US
Practice Address - Phone:412-734-6030
Practice Address - Fax:412-364-6160
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009599235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist