Provider Demographics
NPI:1508059510
Name:KELLY, ERMA F (MED, CCC-SLP, EDS)
Entity Type:Individual
Prefix:MS
First Name:ERMA
Middle Name:F
Last Name:KELLY
Suffix:
Gender:F
Credentials:MED, CCC-SLP, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4948 WHITE OAK PL
Mailing Address - Street 2:
Mailing Address - City:SANDSTON
Mailing Address - State:VA
Mailing Address - Zip Code:23150-5467
Mailing Address - Country:US
Mailing Address - Phone:804-399-5832
Mailing Address - Fax:
Practice Address - Street 1:4948 WHITE OAK PL
Practice Address - Street 2:
Practice Address - City:SANDSTON
Practice Address - State:VA
Practice Address - Zip Code:23150-5467
Practice Address - Country:US
Practice Address - Phone:804-399-5832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202000531235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA208312OtherANTHEM BLUE CROSS/BLUE SH