Provider Demographics
NPI:1619536513
Name:PHILLIPS, KELLY M (SLP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:M
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:889 N AURORA RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:OH
Mailing Address - Zip Code:44202-9537
Mailing Address - Country:US
Mailing Address - Phone:330-954-7177
Mailing Address - Fax:330-995-8279
Practice Address - Street 1:889 N AURORA RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:OH
Practice Address - Zip Code:44202-9537
Practice Address - Country:US
Practice Address - Phone:330-954-7177
Practice Address - Fax:330-995-8279
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.9288235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist