Provider Demographics
NPI:1609099779
Name:CORDERO, KELLY NETT (PHD, CCC SLP)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:NETT
Last Name:CORDERO
Suffix:
Gender:F
Credentials:PHD, CCC SLP
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:LYBB
Other - Last Name:NETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC SLP
Mailing Address - Street 1:2108 E THOMAS RD STE 130
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-0008
Mailing Address - Country:US
Mailing Address - Phone:602-933-1813
Mailing Address - Fax:
Practice Address - Street 1:124 W. THOMAS RD. SUITE 320
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013
Practice Address - Country:US
Practice Address - Phone:602-406-3560
Practice Address - Fax:602-406-7182
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7699235Z00000X
AZSLP9986235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ167928Medicaid