Provider Demographics
NPI:1679955991
Name:MYERS, KELLEY (MS CCC/SLP)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC/SLP
Mailing Address - Street 1:3390 ELDER RD NE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-9335
Mailing Address - Country:US
Mailing Address - Phone:614-205-2071
Mailing Address - Fax:
Practice Address - Street 1:7100 N HIGH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2316
Practice Address - Country:US
Practice Address - Phone:614-505-7330
Practice Address - Fax:614-388-5808
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP. 11582235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist