Provider Demographics
NPI:1578696399
Name:COLCLASURE, KELLY LEE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LEE
Last Name:COLCLASURE
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 1:5814 EAST COUNTY ROAD 100 NORTH
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123
Mailing Address - Country:US
Mailing Address - Phone:317-745-4739
Mailing Address - Fax:
Practice Address - Street 1:3380 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-9089
Practice Address - Country:US
Practice Address - Phone:317-178-0089
Practice Address - Fax:317-718-0097
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004397A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist