Provider Demographics
NPI:1740556265
Name:LIMBECK, KELLY M
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:M
Last Name:LIMBECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2590 ATLANTIC AVENUE
Mailing Address - Street 2:
Mailing Address - City:DENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14625
Mailing Address - Country:US
Mailing Address - Phone:585-249-6500
Mailing Address - Fax:585-248-8412
Practice Address - Street 1:2590 ATLANTIC AVENUE
Practice Address - Street 2:
Practice Address - City:DENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14625
Practice Address - Country:US
Practice Address - Phone:585-249-6500
Practice Address - Fax:585-248-8412
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005754-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist