Provider Demographics
NPI:1780222760
Name:PRESCOTT, KELLY M (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:M
Last Name:PRESCOTT
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 N CHEROKEE AVE
Mailing Address - Street 2:
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711-2910
Mailing Address - Country:US
Mailing Address - Phone:540-560-3423
Mailing Address - Fax:
Practice Address - Street 1:306 DEER PARK RD
Practice Address - Street 2:
Practice Address - City:NEBO
Practice Address - State:NC
Practice Address - Zip Code:28761-8746
Practice Address - Country:US
Practice Address - Phone:828-652-3032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-20
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11150235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty