Provider Demographics
NPI:1508174152
Name:BUCHANAN, KELLY MCGILL (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:MCGILL
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:ANN
Other - Last Name:MCGILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10535 WELCH FAMILY FARM PLACE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE HALL
Mailing Address - State:MD
Mailing Address - Zip Code:20622
Mailing Address - Country:US
Mailing Address - Phone:301-290-0800
Mailing Address - Fax:301-290-1313
Practice Address - Street 1:29770 THREE NOTCH ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:CHARLOTTE HALL
Practice Address - State:MD
Practice Address - Zip Code:20622
Practice Address - Country:US
Practice Address - Phone:301-290-0800
Practice Address - Fax:301-290-1313
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD235Z00000X
MD06602235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist