Provider Demographics
NPI:1497900377
Name:DEMORY, KELLY LYNN
Entity Type:Individual
Prefix:MISS
First Name:KELLY
Middle Name:LYNN
Last Name:DEMORY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10234 SAINT JAMES PL
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-4391
Mailing Address - Country:US
Mailing Address - Phone:219-512-3798
Mailing Address - Fax:219-922-3696
Practice Address - Street 1:10234 SAINT JAMES PL
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-4391
Practice Address - Country:US
Practice Address - Phone:219-512-3798
Practice Address - Fax:219-922-3696
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN46001897A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist