Provider Demographics
NPI:1780016659
Name:MIGLIN, KELLY A (SLPA)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:A
Last Name:MIGLIN
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2322
Mailing Address - Street 2:
Mailing Address - City:CAMP VERDE
Mailing Address - State:AZ
Mailing Address - Zip Code:86322-2322
Mailing Address - Country:US
Mailing Address - Phone:480-703-3281
Mailing Address - Fax:
Practice Address - Street 1:30 E HIGHWAY 260
Practice Address - Street 2:
Practice Address - City:CAMP VERDE
Practice Address - State:AZ
Practice Address - Zip Code:86322-6850
Practice Address - Country:US
Practice Address - Phone:480-703-3281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-02
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA82482355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant