Provider Demographics
NPI:1598338436
Name:DUNCAN, KELLY H (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:H
Last Name:DUNCAN
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 1:1334 WINBORN CIR NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-6955
Mailing Address - Country:US
Mailing Address - Phone:770-330-4754
Mailing Address - Fax:
Practice Address - Street 1:1301 SHILOH RD NW STE 1630
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7168
Practice Address - Country:US
Practice Address - Phone:770-558-5491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP011543235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty