Provider Demographics
NPI:1811539729
Name:HUGHES, KELLY (SLP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:HUGHES
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5816 TROY LN
Mailing Address - Street 2:
Mailing Address - City:SUTHERLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23885-9409
Mailing Address - Country:US
Mailing Address - Phone:804-922-6728
Mailing Address - Fax:
Practice Address - Street 1:14016 BOYDTON PLANK RD
Practice Address - Street 2:
Practice Address - City:DINWIDDIE
Practice Address - State:VA
Practice Address - Zip Code:23841-2500
Practice Address - Country:US
Practice Address - Phone:804-469-4190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202007386235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist