Provider Demographics
NPI:1770631921
Name:KELLY TEASE, MA, CCC-SLP, INC.
Entity Type:Organization
Organization Name:KELLY TEASE, MA, CCC-SLP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:TEASE
Authorized Official - Suffix:
Authorized Official - Credentials:MACCCSLP
Authorized Official - Phone:407-695-8585
Mailing Address - Street 1:218 RINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-4945
Mailing Address - Country:US
Mailing Address - Phone:407-695-8585
Mailing Address - Fax:407-699-9436
Practice Address - Street 1:218 RINGWOOD DR
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-4945
Practice Address - Country:US
Practice Address - Phone:407-695-8585
Practice Address - Fax:407-699-9436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty