Provider Demographics
NPI:1740587252
Name:KELLY, ELIZABETH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:KELLY
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 1:46 FOSTER RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:HOPEWELL JCT
Mailing Address - State:NY
Mailing Address - Zip Code:12533-6112
Mailing Address - Country:US
Mailing Address - Phone:845-223-5113
Mailing Address - Fax:845-592-2744
Practice Address - Street 1:46 FOSTER RD
Practice Address - Street 2:SUITE 8
Practice Address - City:HOPEWELL JCT
Practice Address - State:NY
Practice Address - Zip Code:12533-6112
Practice Address - Country:US
Practice Address - Phone:845-223-5113
Practice Address - Fax:845-592-2744
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007396-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist