Provider Demographics
NPI:1821100470
Name:KELLEY, KAIRN S (MS/CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:KAIRN
Middle Name:S
Last Name:KELLEY
Suffix:
Gender:F
Credentials:MS/CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ALLEN ROW
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-3753
Mailing Address - Country:US
Mailing Address - Phone:802-223-8150
Mailing Address - Fax:802-225-7104
Practice Address - Street 1:130 FISHER RD STE 1-B
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-9516
Practice Address - Country:US
Practice Address - Phone:802-225-7017
Practice Address - Fax:802-225-7104
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010446Medicaid
KE040264Medicare ID - Type Unspecified
VT1010446Medicaid