Provider Demographics
NPI:1710381074
Name:ZULUAGA, KELLY GRAHAM (MS, CCC-SLP/L)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:GRAHAM
Last Name:ZULUAGA
Suffix:
Gender:F
Credentials:MS, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5961 SARATOGA LANE
Mailing Address - Street 2:
Mailing Address - City:COOPERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18036
Mailing Address - Country:US
Mailing Address - Phone:908-763-2735
Mailing Address - Fax:
Practice Address - Street 1:4674 BERWYN LANE
Practice Address - Street 2:
Practice Address - City:MACUNGIE
Practice Address - State:PA
Practice Address - Zip Code:18062
Practice Address - Country:US
Practice Address - Phone:610-909-4051
Practice Address - Fax:610-465-9692
Is Sole Proprietor?:No
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL010423235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist