Provider Demographics
NPI:1639446420
Name:DONNELLY, KERRY ANN (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:ANN
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 ANNANDALE RD
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2405
Mailing Address - Country:US
Mailing Address - Phone:631-689-2091
Mailing Address - Fax:631-689-3544
Practice Address - Street 1:45 ANNANDALE RD
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2405
Practice Address - Country:US
Practice Address - Phone:631-689-2091
Practice Address - Fax:631-689-3544
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010351-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist