Provider Demographics
NPI:1851734438
Name:GROVER, KELLY (MS, SLP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:GROVER
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 MOUNTAIN BROOK DR
Mailing Address - Street 2:
Mailing Address - City:CANDLER
Mailing Address - State:NC
Mailing Address - Zip Code:28715-9405
Mailing Address - Country:US
Mailing Address - Phone:828-712-0487
Mailing Address - Fax:
Practice Address - Street 1:64 MOUNTAIN BROOK DR
Practice Address - Street 2:
Practice Address - City:CANDLER
Practice Address - State:NC
Practice Address - Zip Code:28715-9405
Practice Address - Country:US
Practice Address - Phone:828-712-0487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2627235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist