Provider Demographics
NPI:1629266069
Name:GRIFFITH, KELLY ANN (MHS CCC-SLP/L)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ANN
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:MHS CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6608 GADSBY PARK TER
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-7082
Mailing Address - Country:US
Mailing Address - Phone:804-929-6606
Mailing Address - Fax:
Practice Address - Street 1:6608 GADSBY PARK TER
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-7082
Practice Address - Country:US
Practice Address - Phone:804-929-6606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202007171235Z00000X
WALL00004598235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist