Provider Demographics
NPI:1568775351
Name:BEHAN, KELLY MICHELE (MS, CCC-SLP, TSSLD)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:MICHELE
Last Name:BEHAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 COTTER ST
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-1046
Mailing Address - Country:US
Mailing Address - Phone:516-456-6426
Mailing Address - Fax:
Practice Address - Street 1:280 CROSSWAYS PARK DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2015
Practice Address - Country:US
Practice Address - Phone:516-938-1784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020069235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist