Provider Demographics
NPI:1508093576
Name:KELLEY, ALAINA (MA, SLP)
Entity Type:Individual
Prefix:
First Name:ALAINA
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:MA, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6230 10TH ST N
Mailing Address - Street 2:SUITE 220
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-6158
Mailing Address - Country:US
Mailing Address - Phone:651-739-2300
Mailing Address - Fax:651-739-2302
Practice Address - Street 1:6230 10TH ST N
Practice Address - Street 2:SUITE 220
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-6158
Practice Address - Country:US
Practice Address - Phone:651-739-2300
Practice Address - Fax:651-739-2302
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8482235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist