Provider Demographics
NPI:1679802912
Name:SKILLESTAD, KELLY (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:SKILLESTAD
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:LINKOUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:3545 S OCEAN BLVD
Mailing Address - Street 2:204
Mailing Address - City:PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33480-5741
Mailing Address - Country:US
Mailing Address - Phone:561-523-8689
Mailing Address - Fax:
Practice Address - Street 1:3545 S OCEAN BLVD
Practice Address - Street 2:204
Practice Address - City:PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33480-5741
Practice Address - Country:US
Practice Address - Phone:561-523-8689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8254235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist