Provider Demographics
NPI:1467487660
Name:CHAFFEE, KELLI ELIZABETH (MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:ELIZABETH
Last Name:CHAFFEE
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
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Mailing Address - Street 1:27 HERMITAGE HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148
Mailing Address - Country:US
Mailing Address - Phone:724-342-1789
Mailing Address - Fax:
Practice Address - Street 1:299 EDWARDS ST
Practice Address - Street 2:EASTER SEALS
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44502
Practice Address - Country:US
Practice Address - Phone:330-743-1168
Practice Address - Fax:330-743-1616
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP8311235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0078348Medicaid
OH0078348Medicaid