Provider Demographics
NPI:1598324584
Name:BRONSINK, KELLEY (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:BRONSINK
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 1:4229 BROOKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45223-2162
Mailing Address - Country:US
Mailing Address - Phone:404-423-2992
Mailing Address - Fax:
Practice Address - Street 1:4229 BROOKSIDE AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45223-2162
Practice Address - Country:US
Practice Address - Phone:404-423-2992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.10589235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist