Provider Demographics
NPI:1689822058
Name:CORMELL, KELLY ANN (AUD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:ANN
Last Name:CORMELL
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2470 OLD TURNPIKE RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-6568
Mailing Address - Country:US
Mailing Address - Phone:570-524-3277
Mailing Address - Fax:570-524-3270
Practice Address - Street 1:2470 OLD TURNPIKE RD
Practice Address - Street 2:SUITE 8
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-6568
Practice Address - Country:US
Practice Address - Phone:570-524-3277
Practice Address - Fax:570-524-3270
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006086231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist