Provider Demographics
NPI:1578846556
Name:MCKELVEY, COLETTE
Entity Type:Individual
Prefix:
First Name:COLETTE
Middle Name:
Last Name:MCKELVEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 ULRICH DR
Mailing Address - Street 2:
Mailing Address - City:ROTTERDAM JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12150-9763
Mailing Address - Country:US
Mailing Address - Phone:518-887-3157
Mailing Address - Fax:
Practice Address - Street 1:470 10TH ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-1617
Practice Address - Country:US
Practice Address - Phone:518-328-5603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006591235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist