Provider Demographics
NPI:1518591205
Name:SMITH, KELLY (SLP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 STEFFEE BLVD
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:PA
Mailing Address - Zip Code:16346-3039
Mailing Address - Country:US
Mailing Address - Phone:814-677-1390
Mailing Address - Fax:
Practice Address - Street 1:145 STEFFEE BLVD
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:PA
Practice Address - Zip Code:16346-3039
Practice Address - Country:US
Practice Address - Phone:814-677-1390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL012807235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist