Provider Demographics
NPI:1538462270
Name:MASON, KELLY JEAN (SLPA)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:JEAN
Last Name:MASON
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 1/2 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:EAST MILLINOCKET
Mailing Address - State:ME
Mailing Address - Zip Code:04430-1152
Mailing Address - Country:US
Mailing Address - Phone:207-746-3520
Mailing Address - Fax:
Practice Address - Street 1:6 1/2 BEECH ST
Practice Address - Street 2:
Practice Address - City:EAST MILLINOCKET
Practice Address - State:ME
Practice Address - Zip Code:04430-1152
Practice Address - Country:US
Practice Address - Phone:207-746-3520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant