Provider Demographics
NPI:1588175293
Name:PERO, KELSY (BA)
Entity Type:Individual
Prefix:
First Name:KELSY
Middle Name:
Last Name:PERO
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MISS
Other - First Name:KELSY
Other - Middle Name:
Other - Last Name:PERO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:98 BELLEVUE AVE
Mailing Address - Street 2:
Mailing Address - City:ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01220-2202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:388 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4903
Practice Address - Country:US
Practice Address - Phone:413-499-4537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-20
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1170235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
S15495850OtherLICENSE NUMBER