Provider Demographics
NPI:1508393919
Name:KELLY, SHAWN CHRISTINE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:CHRISTINE
Last Name:KELLY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 NORTHUP WAY STE 120
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-1419
Mailing Address - Country:US
Mailing Address - Phone:425-803-8050
Mailing Address - Fax:
Practice Address - Street 1:2820 NORTHUP WAY STE 120
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-1419
Practice Address - Country:US
Practice Address - Phone:425-803-8050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-16
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist