Provider Demographics
NPI:1659521953
Name:PELLEY, KATHERINE ANN
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANN
Last Name:PELLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6798 CROSSWINDS DR N
Mailing Address - Street 2:STE E-101
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-8603
Mailing Address - Country:US
Mailing Address - Phone:727-823-2529
Mailing Address - Fax:
Practice Address - Street 1:6798 CROSSWINDS DR N
Practice Address - Street 2:STE E-101
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-8603
Practice Address - Country:US
Practice Address - Phone:727-823-2529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ4631235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist