Provider Demographics
NPI:1568699684
Name:MCGINNIS, KELLY ANN (MA CCC SLP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:MCGINNIS
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17414 JADE SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-1155
Mailing Address - Country:US
Mailing Address - Phone:281-253-0088
Mailing Address - Fax:
Practice Address - Street 1:17414 JADE SPRINGS DRIVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-1155
Practice Address - Country:US
Practice Address - Phone:281-253-0088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101421235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist