Provider Demographics
NPI:1598168155
Name:HALDEMAN, KELLY DANAE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:DANAE
Last Name:HALDEMAN
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 1:3288 HOLMES CENTER RD
Mailing Address - Street 2:
Mailing Address - City:BUCYRUS
Mailing Address - State:OH
Mailing Address - Zip Code:44820-9463
Mailing Address - Country:US
Mailing Address - Phone:419-562-7828
Mailing Address - Fax:
Practice Address - Street 1:3288 HOLMES CENTER RD
Practice Address - Street 2:
Practice Address - City:BUCYRUS
Practice Address - State:OH
Practice Address - Zip Code:44820-9463
Practice Address - Country:US
Practice Address - Phone:419-562-7828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-26
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist