Provider Demographics
NPI:1720386345
Name:FLANDERS, KALIE LYNN (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KALIE
Middle Name:LYNN
Last Name:FLANDERS
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10949 BURLINGTON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-9465
Mailing Address - Country:US
Mailing Address - Phone:440-668-7103
Mailing Address - Fax:
Practice Address - Street 1:10949 BURLINGTON RIDGE DR
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-9465
Practice Address - Country:US
Practice Address - Phone:440-668-7103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-06
Last Update Date:2011-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7140235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ#SLP7140OtherAZ CIRTIFICATION