Provider Demographics
NPI:1851444392
Name:KELLY, ANGELA M (MA,CCC-SPL)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:M
Last Name:KELLY
Suffix:
Gender:F
Credentials:MA,CCC-SPL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17314 KEDZIE AVE
Mailing Address - Street 2:
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-1619
Mailing Address - Country:US
Mailing Address - Phone:708-335-0020
Mailing Address - Fax:708-335-0022
Practice Address - Street 1:17929 GOTTSCHALK AVE
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1709
Practice Address - Country:US
Practice Address - Phone:708-206-6155
Practice Address - Fax:708-206-6159
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist