Provider Demographics
NPI:1821243437
Name:MCGLYN, KELLY (MACCCSLP)
Entity Type:Individual
Prefix:MISS
First Name:KELLY
Middle Name:
Last Name:MCGLYN
Suffix:
Gender:F
Credentials:MACCCSLP
Other - Prefix:MRS
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:MCGLYN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MACCCSLP
Mailing Address - Street 1:446 BEMENT AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-2128
Mailing Address - Country:US
Mailing Address - Phone:917-577-6790
Mailing Address - Fax:
Practice Address - Street 1:446 BEMENT AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-2128
Practice Address - Country:US
Practice Address - Phone:917-577-6790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013876235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist